Failure to Provide and Document Hydration for G-Tube Dependent Resident
Penalty
Summary
A deficiency occurred when a resident who was dependent on a gastrostomy tube (G-tube) for nutrition and hydration, and had an order for nothing by mouth (NPO), did not receive appropriate hydration management during their stay. The resident was identified as being at risk for dehydration, with a high score on the Dehydration Risk Screener. Despite this, there was no physician's order for water hydration or flushes, and no documentation that hydration was provided. The Registered Dietician (RD) recommended water flushes of 150 cc every six hours, but this recommendation was not communicated to the physician, not documented in the clinical record, and not implemented by nursing staff. The facility's staff, including the Licensed Vocational Nurse (LVN), Certified Dietary Manager (CDM), and RD, failed to ensure that the RD's hydration recommendation was followed. The LVN did not obtain a physician's order for water flushes, and both the LVN and CDM failed to document the RD's recommendation. The RD did not follow up within the expected timeframe to confirm that her recommendation was implemented. Additionally, the facility did not monitor or record the resident's intake and output (I&O) as required by facility policy for residents with feeding tubes. As a result of these failures, the resident did not receive documented water hydration during their five-day stay and was subsequently transferred to an acute care hospital with diagnoses of sepsis, hypernatremia, and severe dehydration. Facility policies required assessment and implementation of nutrition and hydration programs, as well as monitoring of I&O for residents receiving enteral feedings, but these were not followed in this case.