Failure to Respond Timely to Feeding Tube Alarm
Penalty
Summary
A deficiency occurred when staff failed to respond in a timely manner to a continuous alarm from a resident's gastrostomy tube (GT) pump. The resident, who had a history of chronic respiratory failure, tracheostomy, and required enteral feeding via GT, was observed with the GT pump alarming for nearly half an hour. The alarm indicated a 'Patient Tube Block,' and the resident, who was cognitively intact, expressed annoyance at the persistent beeping. The GT pump was loaded with Jevity 1.2 and water flush, and the feeding was in progress at the time of the incident. During the incident, a Licensed Vocational Nurse (LVN) acknowledged that the alarm should have been checked by another licensed nurse, as the LVN was on the other side of the unit. The LVN was unsure of the cause of the alarm but recognized the importance of addressing it to prevent tube blockage. A Registered Nurse Supervisor later confirmed that proper care and maintenance of tube feeding includes ensuring the tube is not kinked, as this could prevent the resident from receiving the ordered nutrition and could lead to tube clogging. The failure to respond promptly to the GT pump alarm constituted a lapse in providing appropriate care and services for the resident receiving enteral feeding.