Failure to Follow Physician Orders for Enteral Feeding Tube Flushing
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to follow physician orders for the administration of enteral feeding to a resident with a history of cerebral infarction, dysphagia, and gastrostomy status. The resident, who was moderately cognitively impaired and dependent on tube feeding, had specific physician orders requiring the G-tube to be flushed with 130ml of water before and after each feeding. During an observed feeding, the LVN administered half of the prescribed formula without first flushing the tube with water as ordered. Upon realizing the error, the LVN administered the water flush midway through the feeding, followed by the remainder of the formula. The LVN acknowledged during an interview that she forgot to flush the tube with water before the feeding because she was in a hurry, and recognized that this could result in the tube not being cleared and potentially becoming clogged. The Assistant Director of Nursing confirmed that the LVN should have followed the physician's orders and that not flushing the tube first could lead to clogging. Facility policy also required flushing with water at several steps during tube medication administration, as confirmed by record review.