Failure to Ensure Nurse Competency in Checking Gastric Residual Volume
Penalty
Summary
A deficiency was identified when a Licensed Vocational Nurse (LVN) failed to demonstrate appropriate competency in checking the gastric residual volume (GRV) for a resident with a gastrostomy tube (G-tube). The resident in question had diagnoses including dysphagia, muscle weakness, and required all medications via G-tube, with physician orders specifying that GRV should be checked every shift and tube feeding held if GRV exceeded 100 mL. During a medication pass, LVN 3 was observed aspirating only 20 mL from the resident's G-tube and stated that he routinely aspirated only 15 to 20 mL when checking GRV, unaware that more should be aspirated to obtain an accurate measurement. Further interviews revealed that another LVN and the Director of Nursing (DON) confirmed the correct procedure was to aspirate as much gastric content as possible until no more could be withdrawn or resistance was met. Upon re-assessment, LVN 3 found the actual GRV to be 110 mL, significantly higher than the initial 20 mL, acknowledging that the initial method was incorrect. Review of facility policies and procedures (P&P) confirmed that staff were required to aspirate all available gastric contents and take specific actions based on the volume obtained. The resident's records indicated severely impaired cognition and an inability to make decisions, further emphasizing the need for accurate and competent care. Although LVN 3's training records showed prior demonstration of the correct procedure, the observed practice did not align with facility policy or physician orders, resulting in a failure to ensure staff competency in a critical aspect of resident care.