Failure to Administer and Document Tube Feeding per Provider Orders
Penalty
Summary
The facility failed to ensure that a resident who was dependent on tube feeding received nutrition according to provider orders. The resident, admitted with a progressive neurological condition and severe malnutrition, was assessed as cognitively intact and required enteral nutrition. Observations confirmed the presence of tube feeding equipment in use. However, review of the Medication Administration Records (MAR) for both May and June revealed inconsistent and incomplete documentation of the actual amounts of nutrition administered per shift. Nurses often recorded only the hourly rate or a single value, rather than the total amount delivered per shift as ordered. Further review showed that on several occasions, the amount of enteral nutrition administered exceeded the physician's prescribed rate, with overages documented on multiple shifts. The registered dietitian acknowledged that the medical record did not consistently show that the prescribed rate was provided and noted miscommunication regarding MAR documentation requirements. These findings were based on observation, interview, and record review, and were shared with facility staff during the survey.