Failure to Update Enteral Feeding Order to Reflect Current Practice
Penalty
Summary
The facility failed to meet professional standards of practice by not updating a physician’s order for a resident’s enteral feeding regimen. Record review showed an active order dated 11/08/25 for Jevity 1.2 via PEG tube four times a day, and a subsequent order dated 12/01/25 for a regular/liberalized pureed diet with nectar-thick liquids, allowing sandwiches and soft snacks with supervision. During interview, one LPN stated that the resident only receives Jevity through the PEG tube when oral intake is less than 50% of meals, while another LPN reported that the resident no longer receives PEG tube feedings and is eating 100% of meals by mouth and has been doing so for a long time. The nurse practitioner confirmed that the resident is currently eating by mouth and acknowledged that the existing order for PEG tube feeding four times a day had not been updated to reflect the current practice of administering PEG feeding only if the resident consumes less than 50% of the meal orally. The DON also confirmed that the order had not been updated and stated that it should specify that PEG feeding is to be used only when the resident eats less than half of the meal by mouth. This discrepancy between the written physician’s order and the care actually being provided led to the deficiency related to professional standards of quality.
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