Failure to Provide and Document Required G-Tube Site Care
Penalty
Summary
The facility failed to assess and provide appropriate gastrostomy tube (G-tube) site care for four residents who were dependent on staff for all self-care and mobility. Observations revealed that G-tube sites were not properly cleansed or dressed as ordered by physicians. For example, one resident was found with a wet, undated gauze dressing and thick yellow-green drainage around the G-tube site, with moist, red, and rash-covered skin. Documentation showed that required site care was not performed or recorded on multiple occasions, particularly over weekends and specific dates. Another resident was observed with a large amount of yellowish-green drainage and no gauze dressing at the G-tube site, accompanied by foul odors. The nurse acknowledged that a dressing should have been present to manage drainage. Review of treatment administration records indicated missed documentation and lack of PRN orders for additional site care. The Assistant Director of Nursing confirmed that nurses are responsible for inspecting and cleaning G-tube sites every shift, regardless of the scheduled care orders, and should notify physicians of any signs of infection or skin breakdown. Additional residents were found with G-tube sites lacking dressings and with encrusted material present around the insertion area, sometimes seeping through clothing. Physician orders and care plans required daily cleansing and dressing changes, as well as monitoring for infection, but these interventions were not consistently documented or observed. Facility policy specified that G-tube stoma care must include daily cleansing and covering with dry gauze, which was not adhered to for the residents reviewed.