Improper G-Tube Medication Administration and Infection Control by ADON
Penalty
Summary
The deficiency involves the facility’s failure to ensure that services provided via gastrostomy tube (g-tube) were delivered according to professional standards and facility policy for one resident. The resident was an elderly female with a g-tube for nutrition, hydration, and medications, and had multiple diagnoses including cerebral palsy, anxiety disorder, intellectual disability, convulsions, and dementia. Her MDS showed severely impaired cognition and total dependence on staff for all ADLs, and her care plan identified a surgical abdominal site related to peg-tube placement with a goal to remain free from infection. Physician orders specified continuous enteral feeding with a defined formula and rate, free water at a prescribed rate and duration, and multiple medications to be administered via the g-tube. During an observed medication administration via g-tube, the ADON began care by donning gloves without performing hand hygiene, contrary to the facility’s infection control policy that requires hand hygiene before direct resident contact and before assisting with meals. The ADON prepared the medications by separating and crushing them, then attached a 60 cc syringe to the g-tube, checked placement, and instilled 60 cc of water before giving medications. She then used more than 30 cc of water for each medication, exceeding the facility’s enteral tube medication administration policy, which directs staff to flush the tube with only 5–15 ml of water after each medication. During the process, the resident coughed, causing medication to spill from the syringe and spatter around the resident. In response to the spatter, the ADON used the syringe plunger to cover the syringe, placed the plunger on an unclean part of the bedside table outside the established clean field, and then reused the plunger without cleaning it. Her gloves became visibly soiled with medication, yet she did not remove them, perform hand hygiene, or change gloves before continuing care. Additionally, the ADON did not fully dissolve certain medications (Dilantin chewable and omeprazole magnesium), leaving a significant amount of medication residue in the cups, which she discarded into the trash. As a result, the resident did not receive the full doses of all ordered medications. In interviews, the ADON acknowledged she should have washed her hands and changed gloves and stated she had not received facility training on g-tube medication administration, while the RNC confirmed expectations for hand hygiene and adherence to g-tube procedures and reported he could not locate any facility training or in-services specific to g-tube medication administration.
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