Failure to Verify Feeding Tube Placement Prior to Medication Administration
Penalty
Summary
A deficiency was identified when a licensed nurse failed to check for proper placement of a gastrostomy tube prior to administering medication to a resident with a history of acute and chronic respiratory failure and gastrostomy status. The facility's policy and competency guidelines require staff to verify tube placement and patency before administering medications through a feeding tube, specifically by injecting air and listening for a 'whooshing' sound with a stethoscope. During direct observation, the nurse administered medication via gravity using a large syringe without performing the required placement check and did not have a stethoscope available during the procedure. Upon interview, the nurse stated she pushed air into the tube but did not use a stethoscope, claiming she could hear without it. However, inspection of the medication cart confirmed that no stethoscope was present, and the nurse acknowledged this. The facility's policies were reviewed and clearly outlined the steps for confirming tube placement, which were not followed during this medication administration event.