Failure to Maintain Proper Bed Elevation During Tube Feeding
Penalty
Summary
A resident with diabetes mellitus and dementia was admitted to the facility and was receiving nutrition via a nasogastric tube (NGT) at a continuous rate of 40 ml/hour of Glucerna. The resident's care plan and physician's orders specified that the head of the bed (HOB) should be elevated to at least 30 degrees during tube feeding to prevent aspiration. During observation, the resident was found sliding down in bed with the HOB not elevated as required while receiving tube feeding. Certified Nursing Assistant 3 confirmed that the resident's head was not at the appropriate angle and acknowledged it should have been at 30 degrees. Both the Registered Nurse and the Director of Nursing stated that the HOB should be at least 30 degrees or higher during tube feeding, in accordance with facility policy. A review of the facility's policy on enteral feedings indicated that patients should be positioned with the backrest elevated to a minimum of 30 degrees, preferably 45 degrees, prior to and during enteral feeding. Despite these clear directives, staff failed to maintain the required bed elevation for the resident during NGT feeding, as observed by surveyors. This failure to follow established protocols and physician orders constituted a deficiency in care for the resident receiving tube feeding.