Failure to Administer Ordered Free Water Flushes With Enteral Feeding
Penalty
Summary
The facility failed to ensure that a resident receiving enteral nutrition via G-tube received water flushes as ordered by the physician. The resident, an older male with Parkinson’s disease, dysphagia, and a history of PEG tube placement, had physician orders for continuous enteral feeding of Nutritional Formula 1.2 at 50 ml/hr with 50 ml free water flush every hour via G-tube. Review of the physician order summary and the January medication administration record confirmed these orders. During observation, the resident was in bed, awake and moaning, with the head of bed elevated and the enteral feeding pump alarming. The water bag connected to the enteral pump was empty, while the formula bottle was still half full. The water bag and formula bottle were both dated for the early morning of the same day by the night-shift nurse. During interview, the LVN assigned to the resident for the 6 AM–2 PM shift stated she was unaware that the feeding pump alarm was sounding and acknowledged that the alarm was due to the empty water bag. She reported that she checked the resident every two hours to ensure the enteral feeding was being administered according to physician orders and stated that the last time she checked the resident was at 1:20 p.m., at which time there was still water in the bag, though she could not recall the amount. The DON reported that licensed staff had been trained to administer enteral feedings according to physician orders and were expected to check enteral feedings during rounds to ensure feedings and hydration were being administered as ordered. The facility’s enteral feeding policy stated that the facility would follow physician orders and document feedings on the electronic MAR, but the observation of an empty water bag and active pump alarm demonstrated that the ordered free water flushes were not being administered as prescribed.
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