Failure to Follow Physician’s Orders for Tube Feeding Water Flushes
Penalty
Summary
The deficiency involves the facility’s failure to follow a physician’s order for water flushes before and after medication administration and tube feeding for a resident with a gastrostomy tube. The resident had an artificial opening of the gastrointestinal tract, severely impaired cognition, required total staff assistance with ADLs, and received tube feedings. The resident’s care plan directed staff to provide tube feeding and water flushes per the physician’s order. The physician’s order specified administration of one 250 ml carton of Nutrent 2.0 daily at 10:00 AM, with 100 ml of free water to be flushed through the tube before and after each bolus feeding. During an observation, a licensed nurse donned gloves, placed a catheter tip syringe into the resident’s feeding tube, and administered 50 ml of free water, followed by Zofran dissolved in 15 ml of water, then 250 ml of Nutrent supplement, and finally flushed with 50 ml of water. The nurse confirmed she had flushed the tube with 50 ml of water before and after the Zofran administration and 0 ml before the tube feeding, instead of the ordered 100 ml before and 100 ml after the bolus feeding. The nurse stated she had read the order incorrectly. An administrative nurse later stated her expectation that staff verify the order, position the resident properly, and flush with water per the physician’s order when providing medications and supplements via tube. The facility’s enteral tube feeding policy indicated that bolus supplementation orders would be encoded into the computer under the medication order entry program and handled as unit-dose medications.
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