Failure to Notify Family of Changes in G-Tube Status and Treatment
Penalty
Summary
A deficiency occurred when the facility failed to notify a dependent resident's family or representative of significant changes related to a dislodged gastrostomy tube (g-tube) and new antibiotic orders. The resident in question had severe cognitive deficits, was dependent for bed mobility and transfers, and had a care plan indicating impaired cognition with the family managing her care. Despite this, the resident was listed as her own responsible party in the facility's records, and her family members were only listed as emergency contacts. On multiple occasions, nurse notes documented significant events, including the dislodgement of the g-tube and the initiation of antibiotic therapy for a g-tube site infection. While the nurse practitioner and physician were notified and the resident was noted as being aware, there was no documentation that the family or representative was informed of these changes. An interview with the Nurse Consultant confirmed that the resident should not have been listed as her own responsible party, as the family was managing her care.