Failure to Follow Enteral Feeding Orders and Proper Syringe Storage
Penalty
Summary
The facility failed to ensure that enteral tube feeding was administered according to the active physician's order for a resident with severe cognitive impairment and multiple diagnoses, including cerebral infarction, type 2 diabetes, and dysphagia. The physician's order specified that the tube feeding should be administered continuously at 50 ml/hr from 2:00 PM to 10:00 AM, allowing for activities of daily living. However, observations revealed that the tube feeding was still infusing at 50 ml/hr after the designated stop time of 10:00 AM. Interviews with staff indicated that a nurse, who was new to the facility and unfamiliar with the charting system, was unaware of the specific timing of the order. The Assistant Director of Nursing had assisted by hanging the feeding bag earlier in the day, and the nurse did not realize the feeding should have been stopped, resulting in the feeding continuing outside the prescribed hours. Additionally, the facility did not properly store a plastic enteral feeding syringe used for administering medications and water flushes. The syringe was observed with the plunger inside the barrel and droplets of clear liquid present, which could lead to bacterial growth and contamination. Staff interviews confirmed awareness of the correct storage procedure, which was not followed in this instance. The Director of Nursing acknowledged that the plunger should have been removed from the barrel and stored separately, and that the medication aide typically administered medications but was not responsible for tube feedings.