Failure to Maintain Safe Positioning and Handling of Enteral Nutrition
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate care and monitoring for a resident receiving enteral nutrition. The resident had a history of dysphagia following a cerebral infarction and moderate protein-calorie malnutrition, and was dependent on tube feeding and water flushes. Physician orders and the care plan required Jevity 1.5 at 80 mL/hr at bedtime and elevation of the head of bed to at least 30 degrees during feeding. On multiple observations, the resident was found lying flat or with the head of bed not elevated to 30 degrees while the tube feeding was running. During one observation, the assigned LPN acknowledged that the resident was “way too flat” and raised the head of bed to 45 degrees but did not further assess the resident. The facility also failed to ensure proper handling and labeling of enteral feeding formula. Surveyors observed two opened bottles of Jevity on the resident’s tray table, one dated from the previous day and one not dated, both partially full. The running formula bag was not labeled or dated to indicate when the formula was opened or when the feeding was started, and this lack of labeling persisted across several observations on consecutive days. The LPN caring for the resident stated that the open Jevity containers should have been discarded and that nurses were supposed to date enteral feeding formulas with the date and time when opened to ensure the formula was safe and not spoiled. These practices were inconsistent with the facility’s enteral feeding policy, which required residents to be in semi-Fowler’s position (30–45 degrees) during administration and for 30 minutes to one hour after to prevent aspiration.
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