Failure to Follow Physician Orders for Enteral Feeding Administration
Penalty
Summary
The facility failed to ensure that a resident receiving enteral nutrition via a feeding tube was provided with the appropriate treatment and services as ordered by the physician. Specifically, the resident, who had a history of dysphagia and moderate cognitive impairment, had physician orders for her feeding tube to be flushed with 50 mL of water every hour and to receive Jevity 1.2 at a rate of 55 mL/hr. However, observations and interviews revealed that the feeding pump was set to deliver Jevity 1.2 at 65 mL/hr and water flushes at 35 mL/hr, which did not match the physician's orders. Nursing staff admitted to not checking the current orders before administering the feedings and water flushes, and were unaware that the orders had been changed. Further interviews with facility staff, including the ADON and DON, confirmed that there was an expectation for nurses to verify and follow physician and dietitian orders, but this was not consistently done. The ADON acknowledged responsibility for updating orders in the electronic record and monitoring compliance, but had not checked the resident's pump settings since the orders were changed. Training records indicated that not all staff responsible for the resident's care had attended recent in-service training on enteral feeding administration. The facility's policy required staff to check enteral nutrition labels and administration rates against orders, but this was not followed in practice.