Failure to Administer Ordered Enteral Feeding and Verify Gastric Residuals for Residents with PEG Tubes
Penalty
Summary
Staff failed to provide appropriate care and services for residents with percutaneous enteral gastrostomy (PEG) tubes by not administering the correct enteral feeding as ordered and not properly checking gastric residual volumes. For one resident with diagnoses including aphasia, dysphagia, diabetes, and heart failure, the enteral feeding being administered did not match the physician's order, as confirmed by a registered nurse. This resident was dependent on staff for all care and unable to be interviewed due to cognitive impairment. For another resident with severe cognitive impairment and dependent on staff for activities of daily living, staff did not verify the total gastric residual volume before administering medications through the PEG tube. The LPN checked the residual by pulling gastric contents but did not confirm the total volume, and the PEG tube exit site lacked required markings for placement verification. The Director of Nursing confirmed that the resident could not verbalize discomfort and that staff should have verified the full gastric residual volume prior to medication administration, in accordance with facility policy.