Failure to Provide Physician-Ordered Tube Feeding Upon Admission
Penalty
Summary
A deficiency occurred when a resident with a feeding tube did not receive tube feeding administration as ordered by the physician. Upon admission from the hospital, the resident had diagnoses including pneumonia, muscle weakness, acute respiratory failure, dysphagia, protein calorie malnutrition, and cerebral infarction. The resident was assessed as having mild cognitive impairment and required assistance with daily activities. The care plan specified the need for tube feedings due to swallowing difficulties, with interventions including elevating the head of the bed, providing tube feeding and water flushes per physician orders, and monitoring nutritional intake. Despite these documented needs, the physician's orders for enteral feeding were not entered into the resident's computerized physician orders (CPO) until five days after admission. The hospital discharge summary included specific instructions for continuous enteral feeding and water flushes, but there was no documentation in the electronic medical record (EMR) indicating that these orders were followed from the time of admission until they were entered into the CPO. As a result, the resident did not receive the prescribed tube feeding during this period. Interviews with facility staff confirmed that the admitting nurse did not transcribe or verify the hospital discharge orders with the facility physician upon admission. The registered dietitian and regional clinical resource both stated that it was the responsibility of the admitting nurse to ensure all physician orders, including those for tube feeding, were entered and initiated. The failure to do so resulted in the resident missing necessary nutritional support as ordered by the physician.