Lack of Physician Order for Abdominal Binder Used to Secure G-Tube
Penalty
Summary
A deficiency was identified when a resident with severe cognitive impairment and dependent on a gastrostomy tube (g-tube) for nutrition did not have a physician's order for an abdominal binder that was being used to secure and protect the g-tube. The resident had a history of pulling out her g-tube during care, as documented in progress notes and confirmed by staff interviews. The abdominal binder was implemented to prevent further incidents of the resident pulling out her g-tube, and staff reported that no further incidents occurred after its use. Despite the use of the abdominal binder as an intervention, review of the resident's medical records and physician orders revealed that there was no physician's order for the binder. The Director of Nursing stated that an order was not required because the binder was considered protective rather than a treatment, while the physician indicated that an order should have been in place. The facility's policy required that enteral nutrition and related interventions be provided as ordered, but the lack of a physician's order for the abdominal binder constituted a failure to ensure appropriate treatment and services for the resident receiving enteral feeding.