Failure to Follow Physician Orders for Enteral Feeding Rate
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident receiving enteral nutrition via a gastrostomy tube was provided care in accordance with physician orders. The resident, who had a history of nontraumatic intracerebral hemorrhage, diabetes mellitus, and dysphagia following a stroke, was observed with her feeding pump set at 60 ml/hr, despite a physician order specifying a rate of 50 ml/hr. The care plan and physician orders detailed the required formula, feeding rate, and water flushes, but these were not followed as observed during the survey. Interviews with nursing staff and review of facility policy confirmed that the enteral feeding pump rate should match the physician's order, and that it is the responsibility of nursing staff to verify and set the correct rate. The incorrect rate was identified by a nurse during rounds, who acknowledged the error and reported it to the ADON. Both the ADON and DON stated their expectations that nurses follow physician orders and verify pump settings during rounds, as outlined in facility policy. The failure to follow the physician's order for the enteral feeding rate constituted the deficiency.