Improper Management of Enteral Feeding During Resident Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure appropriate treatment and services for a resident receiving enteral nutrition. The facility could not provide a tube feeding policy when requested by the surveyor and instead produced an undated tube feeding audit form that stated the head of the bed should be elevated 30–45 degrees during feeding. The resident involved had significant medical conditions, including anoxic brain damage, dysphagia, chronic respiratory failure, quadriplegia, and pneumonitis due to inhalation of food and vomit, and required G-tube feeding to maintain adequate caloric and nutritional status. The resident’s care plan, initiated and revised in April and May, directed staff to hold tube feeding during care, turning, and repositioning, and to resume feeding when complete with the head of bed elevated. During an observation of personal care, a CNA entered the resident’s room, donned gloves, and lowered the resident’s head of bed to a flat position while the Nepro 1.8 tube feeding continued to run at 45 ml. The CNA removed the resident’s gown and requested a respiratory therapist to check the resident’s trach collar, which was then tightened before the therapist left the room. The CNA did not stop the tube feeding before lowering the head of the bed and only placed the feeding on hold after the surveyor questioned the ongoing feeding while the resident was lying flat. Later, when asked, the ADON stated that the expectation when providing care to a resident with a running tube feeding is to stop the feeding, confirming that the observed practice did not meet facility expectations or the resident’s care plan directives.
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