Failure to Administer Tube Feeding per Physician Orders
Penalty
Summary
The facility failed to ensure that a resident receiving enteral nutrition via feeding tube was administered the correct feeding rate as per physician orders. The resident, a male with a history of aphasia, stroke, hemiplegia, and severe cognitive impairment, was dependent on staff for eating and required tube feedings due to dysphagia. Physician orders specified a continuous feeding rate of 55 ml/hour, but observations and interviews revealed that the resident was instead receiving feedings at a rate of 60 ml/hour on multiple occasions. Family members and staff noted the discrepancy in the feeding rate, with the feeding pump and formula bag both indicating a rate of 60 ml/hour. Nursing staff, including an LVN, acknowledged administering the higher rate and stated that there was confusion regarding whether the physician order had been updated to reflect the new rate. However, the order in the system had not been updated, and the resident continued to receive feedings at the incorrect rate. The LVN and Unit Manager both confirmed that nurses were responsible for entering and updating physician orders, and that the Unit Manager was responsible for reviewing all orders for accuracy, but these processes were not followed in this case. The Director of Nursing (DON) confirmed that the resident was receiving a feeding rate inconsistent with the documented physician order and stated that nurses were responsible for following the orders as written. Facility policy required that feeding tubes be managed according to physician orders, including the specific rate and type of feeding, and that administration be periodically evaluated for consistency with those orders. The failure to administer the feeding at the prescribed rate constituted a deficiency in care for residents receiving enteral nutrition.