Failure to Follow Protocols for G-Tube Feeding and Care
Penalty
Summary
The facility failed to provide appropriate treatment and services for a resident receiving enteral nutrition via a gastrostomy tube (G-tube). The surveyor found that the facility could not provide a policy or protocol for verifying G-tube placement during the onsite survey, and the only available policy addressed medication administration, not feeding. Clinical records showed that the resident had a recent PEG tube placement due to esophageal dysmotility and had physician orders for tube feeding, including checking tube placement and residuals three times daily. However, during observation, a registered nurse administered water and liquid nutrition by pushing the plunger of a syringe rather than allowing the fluids to flow by gravity, as required by the facility's competency process. The nurse did not verify tube placement or check for residuals before administering the feeding and was unaware of the correct insertion depth for the resident's G-tube. Additionally, the nurse failed to perform proper hand hygiene after removing soiled gloves and before donning new gloves while providing G-tube care. The nurse confirmed during an interview that she did not use the gravity method, did not check tube placement, and did not assess for residuals prior to feeding. The facility's documentation of staff competency indicated that the gravity method should be used, and the procedural steps did not include using a plunger for the entire process. These actions and omissions resulted in a failure to follow physician orders and facility protocols for safe G-tube feeding and care.