Failure to Administer Ordered Continuous Tube Feeding
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident’s ordered continuous enteral tube feeding was administered as prescribed. During an observation, the resident reported having a tube feeding and stated that he did not want the tube feeding running while he was eating, but also reported that the nurse had not started his tube feeding at all that day. The admission record documented that the resident had chronic respiratory failure, a tracheostomy, a history of liver transplant, a gastrostomy tube, and seizures. An order summary for enteral feeding directed Nepro 1.8 at a rate of 45 ml/hour for 24 hours, with a total volume of 1,080 ml, and the care plan included an intervention to administer tube feeding as ordered. Interviews with facility staff confirmed expectations that tube feedings be administered according to the physician’s order or adjusted by the nurse practitioner if needed to accommodate resident preferences. One staff member stated that all tube feedings were expected to be given as ordered or adjusted by the nurse practitioner, and another staff member acknowledged that the resident refused tube feeding during meals but stated that the feeding was expected to be administered when the resident was not eating by mouth. The facility’s enteral nutrition policy required nursing staff to follow enteral nutrition guidelines, ensure continuous drip feedings were administered appropriately, and closely monitor tube feeding tolerance and intake to ensure nutritional goals were met, including confirming that enteral nutrition was delivered as ordered by the physician. Despite these policies and orders, the resident’s tube feeding was not initiated as ordered on the day observed.
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