Failure to Maintain Physician Orders and Care for Resident with Gastrostomy Tube
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent complications for a resident with a gastrostomy feeding tube. Specifically, after all enteral feed orders were discontinued, the resident continued to have a gastrostomy tube in place but did not have physician orders for the volume, frequency, and type of flush to maintain tube patency, nor for the frequency of cleaning and care of the tube site. As a result, no enteral feeding care, including flushes or site care, was administered for an extended period while the tube remained in place. The resident involved was an older female with diagnoses including protein-calorie malnutrition, dysphagia, Parkinson's disease, and abnormal weight loss. She had moderate cognitive impairment but was able to understand and be understood. Although she required tube feeding due to dysphagia, she chose to eat by mouth and was not receiving nutrition via the tube during the period in question. The care plan indicated the need for daily cleansing of the insertion site and monitoring for infection or tube dysfunction, but these interventions were not carried out due to the lack of physician orders. Interviews with nursing staff, the DON, and the resident's physician confirmed that nurses were responsible for obtaining and maintaining appropriate physician orders for tube care and flushing. The DON and staff were unaware that the orders had been discontinued, and the facility's policy did not specify requirements for flushing or cleaning the insertion site. The absence of orders and care placed the resident at risk for tube obstruction, malfunction, and infection, as noted by the staff and physician during interviews.