Failure to Administer Enteral Feedings as Ordered
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident receiving enteral nutrition via feeding tube was provided with the appropriate treatment and services as ordered by the physician. The resident, a male with severe cognitive impairment, multiple diagnoses including anemia, diabetes mellitus, Alzheimer's disease, and malnutrition, was dependent on a feeding tube and had specific physician orders for the administration of Glucerna 1.5 Cal via PEG tube every four hours. The care plan also included detailed interventions for monitoring and maintaining the resident's nutritional status, including water flushes and head-of-bed elevation. Record review revealed that the resident did not receive the prescribed Glucerna 1.5 feedings on three occasions, as documented in the medication administration record (MAR). Interviews with nursing staff and the DON confirmed that these feedings were missed, and there was no documentation in the clinical record to explain the omissions or indicate that the orders had been placed on hold. Nursing staff were unable to recall or provide reasons for the missed feedings, and the DON verified that the missed administrations were not supported by any progress notes or documentation. The facility's policy required that physician orders be implemented and documented promptly, with any changes or holds to be recorded in the resident's medical record. The lack of adherence to these orders and the absence of documentation for the missed feedings constituted a failure to follow physician directives and provide the necessary care for the resident's enteral nutrition needs.