Improper Storage and Drying of Enteral Flush Syringe
Penalty
Summary
The deficiency involves the facility’s failure to properly store and dry a plastic syringe used for enteral water flushes for a resident with a gastrostomy tube. The resident was admitted with muscle weakness, malnutrition, adult failure to thrive, gastrostomy status, and dysphagia, and was receiving tube feeding with an average fluid intake of 501 cc/day or more via IV fluids or tube feeding. The resident had a physician’s order for 60 ml water flushes four times a day through the feeding tube. During an observation and interview, the syringe used for these ordered water flushes was found on the bedside table with the plunger inserted and visible clear condensation inside. The syringe was stored in a plastic bag dated several days earlier, and the resident reported that nursing staff rarely left the syringe apart to allow it to air dry after use. The resident stated that around 9:00 AM that day, a nurse had administered the ordered water flush and then reassembled the syringe and left it on the bedside table. Review of the Medication Administration Record confirmed that the nurse had signed off the morning flush at that time. In an interview, the nurse acknowledged providing the water flush earlier in the shift and stated she was not aware that the syringe needed to be dried before being placed back in the storage bag, and that while she knew to wash the syringe if residue was present, she did not know the plunger should be separated to air dry to prevent bacterial growth. A subsequent observation with the DON showed the syringe at the bedside still wet with the plunger inside. The DON stated that the syringe and plunger should be washed and the plunger left out to air dry to prevent bacterial growth, and that facility policy required plastic syringes to be discarded every 24 hours and stored with the plunger removed after use. The Administrator also stated that the nurse should have washed the syringe and allowed it to dry completely to prevent bacterial growth.
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