Failure to Obtain and Implement Physician Orders for GJ Tube Maintenance
Penalty
Summary
The facility failed to request and implement physician's orders for the monitoring and maintenance of a Gastrojejunostomy (GJ) tube for a resident with a Duopa pump, resulting in a lack of clear direction for staff regarding tube care. The resident, who had a history of progressive neurological condition, Parkinson's Disease, and other significant medical issues, had a Duopa pump installed for medication administration. After the facility was unable to obtain medication cartridges, the pump was not used for over six months, but the resident wished to keep the j-tube in place for potential future use. Despite this, staff did not obtain clarification orders for the maintenance or flushing of the tube while it was not in use, and documentation on the Medication Administration Record (MAR) indicated that required flushes were not consistently completed. Interviews with facility staff and physicians revealed confusion and lack of responsibility regarding who should provide orders for the tube's maintenance. The Primary Care Physician (PCP) was unaware of the specific requirements for the Duopa pump tubing and deferred responsibility to the neurologist, while the neurologist's office stated that maintenance orders were only given while the pump was in use. The gastroenterologist who placed the tube indicated that the tubing should be replaced every six months and that maintenance orders should have been provided by the physician managing the medications. No one from the facility contacted the appropriate providers to clarify ongoing care for the tube during the period it was not in use. The facility's policy required staff to have clear direction on the frequency and volume of tube flushing, as well as guidance on tube replacement. However, these procedures were not followed, and there was no documentation of staff receiving or following specific orders for the care of the resident's GJ tube during the period it was not being used for medication administration. This lack of communication and failure to obtain and implement appropriate physician orders led to the deficiency identified during the survey.