Failure to Follow G-Tube Flush Orders During Medication Administration
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to follow physician orders for water flushes during medication administration via a gastrostomy tube (G-tube) for a male resident with a history of traumatic brain dysfunction, respiratory failure, and gastroesophageal reflux. The resident's care plan and physician orders specified that the G-tube should be flushed with 30 cc of water before and after medications, and 15 cc of water between each medication. During observation, the LVN prepared and crushed six medications, administered them sequentially through the G-tube, but did not flush the tube with water between each medication as ordered. Instead, the LVN only performed a flush before the first medication and after the last, omitting the required flushes between each medication. Upon interview, the LVN acknowledged overlooking the physician's orders and admitted not flushing the G-tube as required, which could result in tube clogging. The Director of Nursing (DON) confirmed that staff are expected to follow physician orders for G-tube flushes and that failure to do so could lead to complications. The facility's policy also required irrigation of the feeding tube before, between, and after medication administration, which was not followed in this instance.