Failure to Reconcile Enteral Feeding Orders Resulting in Missed Nutrition
Penalty
Summary
A deficiency occurred when a resident with multiple complex medical conditions, including chronic hypoxic respiratory failure, severe protein-calorie malnutrition, septic shock, diabetes type 2, and a gastrostomy, was readmitted to the facility. Upon readmission, there was no physician order for enteral feeding/nutrition, and an NPO (nothing by mouth) order was in place. The resident did not receive tube feeding or nutrition for approximately 19 hours following readmission, as documented in the electronic medical record (EMR) and confirmed by staff interviews and record reviews. Progress notes indicated that staff were aware the resident had not received their prescribed Glucerna tube feeding since returning from the hospital, and the feeding was not initiated until the following morning after staff made calls to confirm orders. There was no documentation clarifying who was contacted for the order, nor was there evidence that the physician was notified of the missed tube feeding. Additionally, the resident's condition deteriorated, with lethargy, decreased oxygen saturation, and a high glucose level, leading to rehospitalization. Further review revealed that hospice documentation and hospital discharge medication lists were missing from the EMR at the time of readmission, and the hospice nurse may have inadvertently taken these documents. The facility's admission policy requires written physician orders for immediate care, including dietary instructions, but these were not present. The lack of clear orders and documentation resulted in a failure to provide essential tube feeding/nutrition to the resident for an extended period.