Failure to Ensure Competent G-Tube Care and Response to Resident Pain
Penalty
Summary
Nursing staff failed to demonstrate appropriate competency in the care of a resident with a PEG feeding tube, resulting in missed medication administration and improper response to pain during tube feeding. The resident, who had moderately impaired cognition and multiple diagnoses including dysphagia, stroke with hemiplegia, and aphasia, was dependent on tube feeding for more than half of his caloric intake. On one occasion, a registered nurse was unable to administer scheduled evening medications because he could not access the resident's new feeding tube, citing the absence of a specific syringe. The nurse did not contact the on-call nurse or escalate the issue, resulting in the resident missing his medications. It was later determined that available piston syringes would have sufficed for medication administration. On a subsequent shift, another nurse continued to administer tube feeding to the same resident despite the resident's complaints of severe pain and visible discomfort. The nurse attributed the resident's reaction to possible hunger or post-surgical tenderness and did not stop the feeding or seek further assessment. The resident's abdomen was later found to be distended and painful upon examination. Facility policy required staff to utilize feeding tubes according to clinical standards and to monitor for complications, but staff failed to follow these protocols, leading to the deficiency.