Failure to Administer Ordered G-Tube Feeding and Water Flushes
Penalty
Summary
The deficiency involves the facility’s failure to provide gastrostomy tube (g-tube) feedings and water flushes as ordered for a resident who was dependent on tube feeding for nutrition and hydration. The resident had diagnoses including hypertension, stroke, dementia, short- and long-term memory loss, and required total staff assistance for all ADLs. The resident’s MDS indicated the presence of a feeding tube and that more than 51% of total calories and fluids were received via the tube. The care plan identified risk for altered nutrition and hydration related to difficulty swallowing and a history of failed swallow test, with approaches including providing tube feeding and water flushes as ordered. Physician orders directed Jevity 1.5 Cal at 45 ml/hr for 23 hours per day and g-tube water flushes of 150 ml every four hours. On the survey day, observations showed that at 10:38 A.M. the resident was not in the room while the Jevity and water were hanging on the IV pole next to the bed, and at 10:48 A.M. the resident was seated in the hallway across from the nurse’s station without the tube feeding or water attached, while an RN sat at the nurse’s station in full view of the resident. At 1:45 P.M., the resident was back in bed with the Jevity and water still hanging on the pole and not connected to the resident. A CNA reported getting the resident up around 9:00 A.M. and placing the resident at the nurse’s desk. The RN responsible for the resident initially stated the tube feeding was ordered to begin in the afternoon, but upon reviewing the physician orders acknowledged that the tube feeding should have been restarted when the resident was gotten out of bed. Facility policies required that tube feedings be administered according to physician orders and that any failure to implement an order be promptly reported to the physician and DON, but the ordered continuous tube feeding and scheduled water flushes were not provided during the observed period.
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