Failure to Provide Ordered G-Tube Care and Dressing
Penalty
Summary
The deficiency involves the facility’s failure to provide gastrostomy tube (G-tube) care and maintenance as ordered for a resident who was fully dependent on tube feeding. The resident had multiple diagnoses including dementia, acute respiratory failure, Type II diabetes mellitus with diabetic neuropathy, dysphagia, history of aspiration pneumonia, a G-tube, and hypertension, and was documented on the MDS as being in a persistent vegetative state, severely cognitively impaired, unable to make needs known, dependent for all ADLs, incontinent, and receiving all nutrition via feeding tube. The care plan identified potential for altered nutrition/hydration, with the resident ordered NPO and dependent on tube feeding and flushes, and included interventions such as administering medications as ordered, elevating the head of bed, and evaluating tube feed tolerance. Physician orders specified continuous tube feeding with Glucerna 1.2 via G-tube for up to 20 hours per day with scheduled water flushes, and a treatment order to cleanse the area around the G-tube with soap and water and apply a new sponge dressing daily and as needed. During an observation, an LPN entered the resident’s room and exposed the G-tube site, at which time no dressing (sponge) was in place despite the physician’s order for a daily dressing. The LPN cleansed a small amount of brown/red dried drainage from the G-tube insertion site and confirmed that a dressing should have been applied. In an interview, the DON stated that the facility did not have a policy or procedure in place regarding the provision of G-tube care and maintenance, and that the procedure was considered a standard of practice task. The facility also identified two additional residents with G-tubes, indicating that more than one resident required such care, but the cited deficiency specifically involved the failure to follow ordered G-tube care for this resident.
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