Failure to Flush G-Tube, Label Tube Feeding, and Follow EBP for G-Tube Care
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders and facility policy for gastrostomy tube (g-tube) management, including flushing after bolus feedings, proper labeling of tube feeding, and adherence to Enhanced Barrier Precautions (EBP). A cognitively intact resident, dependent on staff for feeding and admitted with diagnoses including gastrostomy status, malnutrition, dysphagia, and post-coronary artery bypass graft status, had physician orders for Osmolite 1.5 tube feeding 350 mL four times daily and water bolus flushes of 115 mL every six hours. The resident’s care plan documented increased tube feeding volume due to weight loss. During observation, an LPN turned off the resident’s tube feeding, disconnected the feeding line from the g-tube, and plugged the tube without flushing it afterward, stating the resident had already been flushed earlier and would be flushed later, despite the expectation from the DON and Administrator that a g-tube should be flushed with at least 30 mL of water after a bolus feeding. The same observation showed the tube feeding bottle labeled only with the date and the word “Osmolite,” with no time hung or rate of infusion, contrary to facility policy requiring the resident’s name, formula, rate, and date/time on the bottle, and staff interviews confirming that practice. The bottle was dated the previous day with no indication of when it was started. Additionally, the resident had a physician order for EBP due to MDRO risk related to the g-tube, but there was no PPE at the room entrance and the LPN did not don PPE while providing g-tube care. Other LPNs interviewed stated that they always flush g-tubes before and after feedings, that feeding bottles should be fully labeled with name, date, time, and rate, and that residents with g-tubes or PICC lines should be on EBP with staff wearing gown, gloves, and mask, underscoring that the observed care did not follow the facility’s established practices and policies.
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