Failure to Follow Enteral Feeding and G-Tube Medication Administration Protocols
Penalty
Summary
The deficiency involves the facility’s failure to follow its own policies and physician orders for enteral (tube) feeding management and medication administration for one resident with a G-tube. During an observation, an RN administered a medication via the resident’s enteral tube without checking tube placement beforehand. The nurse acknowledged that she did not verify placement, despite stating that tube feeding placement should be checked prior to medication administration using a pH strip or by aspiration. The tube feeding site was covered with a clean, dry dressing, but no other placement confirmation was identified. The tube feeding bottle was infusing at 50 mL/hr, but the container did not have a visible start time, and the nurse stated she could not determine when the feeding had been started, noting that there should be a start time of infusion. The RN also flushed the tube with 60 mL of tap water before administering the medication and 90 mL of water afterward, explaining that she gives extra flushing because the resident does not drink water. The DON later stated that nurses should check tube placement before medication administration, that the tube feeding container should include the resident’s name, rate, and start time, and that tube feedings should be flushed according to the physician’s order and facility policy. The physician’s order specified Jevity 1.2 at 50 mL/hr starting at 3 p.m. for 21 hours or until 1050 mL is reached per day, with a 150 mL flush every 6 hours. Facility policies required that feeding bags be labeled with the date and time feeding was started, that G-tube placement be checked by tube marker location and gastric content aspiration with pH confirmation, and that the G-tube be flushed with 15–30 mL of water before and after medications. These requirements were not followed during the observed medication pass.
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