Improper Oral Water Administration to NPO PEG-Fed Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide care consistent with professional standards for a resident receiving enteral nutrition who was ordered NPO with PEG tube feeding for all nutrition, hydration, and medications. The resident had a history of stroke, malnutrition, dehydration, GERD, dysphagia, aphasia, anemia, and failure to thrive, with a speech evaluation documenting moderate oral dysphagia and clinical signs of pharyngeal dysphagia. The care plan identified swallowing and nutritional problems, including use of enteral feedings via PEG and an NPO status, with interventions specifying tube feeding as ordered and diet to be followed as prescribed. Despite these orders and assessments, staff were observed providing water orally to the resident using sponge-tipped mouth swabs. A CNA repeatedly dipped a mouth swab into a Styrofoam cup of water and placed it into the resident’s mouth multiple times without squeezing out excess water, while the resident sucked water from the sponge. The CNA stated that the resident had requested water several times that morning and that she had given him water with the swab each time he asked. Another CNA reported that the resident was on a fluid restriction, was NPO, and received water via his feeding tube, and that staff were supposed to use lemon mouth swabs to keep his mouth moist because he could not have anything by mouth. Additional observations and interviews showed that the resident continued to request water, that lemon swabs were intended to be used in place of water due to his NPO status, and that there was no specific order for mouth swabs, with oral care treated as a standard of care. A physician progress note documented that a full cup of water had been found at the bedside of this NPO resident with a PEG tube, with nursing staff reporting it was for oral care. Another progress note described the resident with brown-colored emesis on his gown and linens, with tube feeding held pending evaluation for possible obstruction. The unit manager confirmed the resident should not have received water because he was not swallowing and that oral care directions in the Kardex and care plan were unclear, noting that brushing his teeth and rinsing could result in aspiration.
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