Failure to Follow G-Tube Feeding Orders and Provide Site Care
Penalty
Summary
A deficiency was identified when a resident with a gastrostomy tube (G-tube) did not receive care and services in accordance with physician orders and facility policy. The resident had an order for enteral feeding with Jevity 1.5 at 65 mL/hour for 20 hours, to be stopped at 10:00 AM and restarted at 2:00 PM. However, multiple observations by the surveyor showed that the tube feeding continued to run during the period it was supposed to be off. Staff members, including CNAs and an LPN, were unclear about the feeding schedule, with some believing the feeding was continuous. The feeding was also observed to be leaking, resulting in formula on the resident's bed sheet. Further review revealed that there were no physician orders or documented interventions for monitoring, treatment, or care of the resident's G-tube site. The facility's policy required daily assessment and care of the G-tube site, including cleaning, monitoring for infection, and documentation of care provided. Interviews with staff, including the LPN, unit manager, and DON, confirmed that there were no orders or documentation for G-tube site monitoring or care on the resident's MAR/TAR or care plan. Staff were unsure about the expectations for G-tube care and could not locate relevant information in the resident's records. The resident in question had significant medical needs, including anoxic brain damage, chronic respiratory failure, protein-calorie malnutrition, and was dependent on staff for all activities of daily living. The resident was nonverbal, unable to follow commands, and at high risk for malnutrition. Despite these vulnerabilities, the facility failed to ensure that the resident's G-tube feeding was administered as ordered and that appropriate monitoring and care of the G-tube site were provided and documented.