Failure to Follow Enteral Feeding Flush Orders for PEG Tube Resident
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for enteral feeding flushes for a resident with a PEG tube. The resident was an older female with dysphagia, aphasia, a history of cerebral infarction, and a history of aspiration, who was NPO and dependent on tube feeding and water flushes for nutrition and hydration. Her quarterly MDS showed she received more than half of her total calories via PEG tube. The active physician order and MAR specified TwoCal 2.0 at 80 ml/hr for 20 hours with a free water flush (FWF) of 45 ml every hour while the feeding was running. During observation of the tube feeding pump, the formula rate was correctly set at 80 ml/hr, but the water flush was programmed to deliver 45 ml every two hours instead of every hour as ordered, while the feeding was connected and running. An LVN confirmed that the order was for 80 ml/hr with a 45 ml water flush every hour and acknowledged that the pump was set to flush every two hours. The LVN stated that night nurses hung the feeding and day nurses restarted it. The DON stated that nurses were expected to ensure the feeding rate and flushes matched the physician’s orders and that they should check pump parameters accordingly. The facility’s policy on care and treatment of feeding tubes required that feeding tubes be utilized according to physician orders, including the frequency and volume of flushes, and that the RD be used to estimate nutritional and hydration needs. The surveyors requested recent training related to this area, and none were provided before exit.
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