Improper Administration of G-Tube Medications
Penalty
Summary
A deficiency was identified when a nurse failed to follow proper procedures for administering medications through a gastrostomy (G-tube) for a resident with a history of cerebral infarction, dysphagia, and who was NPO, requiring all nutrition, fluids, and medications via G-tube. The resident's care plan and physician orders specified that medications should be given one at a time, each diluted with water, and the tube flushed with water before and after each medication. The facility policy also required that medications not be mixed together unless there was a physician's order and that medications should be administered by gravity, not by using the syringe plunger. During a medication pass, the nurse crushed six tablets together, added a laxative powder and liquid medications, and mixed them all in a single cup with water, creating a medication cocktail. She then attempted to administer the entire mixture through the G-tube at once. When the mixture stopped flowing, she used the plunger of the syringe, inserting and rocking it to force the medication through the tube, rather than allowing it to flow by gravity as required by policy. The nurse acknowledged during interview that she did not have an order to mix the medications and that she was aware of the correct procedure but deviated from it because she was nervous during observation. The Director of Nursing confirmed that the facility policy was not followed, reiterating that medications should be given one at a time, diluted with water, and administered by gravity without use of the syringe plunger. The nurse had previously demonstrated competency in the correct procedure during skills observation, but failed to adhere to these standards during the observed medication administration.