Failure to Follow Physician Orders for Enteral Nutrition
Penalty
Summary
The facility failed to ensure that residents receiving enteral nutrition via feeding tubes were provided care in accordance with physician orders, resulting in deficiencies for two residents. For one resident with severe cognitive impairment and a diagnosis of malnutrition and Alzheimer's disease, the prescribed enteral formula (Isosource 1.5) was not available, and staff substituted it with a different formula (Jevity 1.5) without obtaining or documenting a physician order for the change. Observations confirmed that the substituted formula was administered over multiple days, and interviews with nursing staff and the DON revealed that although the nurse practitioner verbally approved the substitution, the required documentation and order entry were not completed. There was also no monitoring tool in place to ensure the correct formula was administered. For another resident with severe cognitive impairment and total dependence for eating, the facility failed to follow physician orders regarding the timing of enteral feedings. The resident's order specified that the feeding pump should be turned off at 8:00 AM and restarted at 12:00 PM to allow for a four-hour break. However, observations showed that the feeding continued past the prescribed stop time and was restarted before the full break was completed, resulting in less than the ordered downtime. The nurse responsible for the resident's care acknowledged not adhering to the order and had not contacted the physician or documented the deviation. Record reviews of the facility's policies confirmed that staff were required to administer enteral nutrition consistent with practitioner orders, including formula type, rate, and timing. Both the DON and ADON confirmed that it was the responsibility of nursing staff to follow these orders and document any changes or deviations, which did not occur in these cases.