Failure to Follow Feeding Tube Policies and Physician Orders
Penalty
Summary
Staff failed to follow facility policy and physician orders regarding the care and management of feeding tubes for two residents. For one resident with a history of hemiplegia, malnutrition, diabetes, and dysphagia, staff did not consistently document the percentage of meals and fluid intake after a certain date, despite orders to monitor and document intake and output. Observations showed the resident's head of bed was not elevated to the required degree during tube feeding, and the feeding pump and formula bag were not always labeled with necessary information such as the formula name, date, and time hung. Interviews revealed confusion among staff regarding who was responsible for feeding assistance and documentation, with both LPNs and CNAs unsure of the resident's dietary needs and intake. Another resident with dysphagia, diabetes, and a PEG tube also experienced lapses in care. Staff did not document meal and fluid intake as required, and the feeding pump and formula bag lacked proper labeling. Observations showed the resident had access to thin liquids despite a diet order for nectar thick fluids, and there was no documentation of food or fluid intake in the progress notes. The resident reported not receiving breakfast and demonstrated access to inappropriate fluids, indicating a lack of adherence to dietary orders. Interviews with staff, including the DON and Administrator, confirmed expectations that staff should follow facility policies, physician orders, and care plan interventions, including proper positioning during tube feeding and accurate documentation. However, the observed and documented actions showed that these expectations were not met, leading to deficiencies in the care provided to residents with feeding tubes.