Failure to Follow PEG Tube Feeding Orders and Discontinue Unneeded PEG Tube
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents with PEG tubes received treatment and services according to professional standards and physician orders. Facility policy required staff to follow physician orders, provide proper care and maintenance of gastrostomy tubes, and assess residents for pain or discomfort at the tube site. For one resident with impaired memory, inability to communicate verbally, a brain injury, and swallowing difficulty, the care plan identified a need for tube feeding via PEG to meet nutritional requirements, and a physician’s order directed that 1700 ml of tube feeding be administered over 20 hours daily. Review of this resident’s Medication Administration Record for an entire month showed that on 28 of 30 days, the resident received less tube feeding volume than ordered, with documented daily totals consistently below 1700 ml and on some days significantly lower. The Administrator and Infection Preventionist/Staff Development acknowledged on review that the resident did not receive the ordered amount of tube feeding, and the DON stated that nursing staff were expected to follow and implement physician tube feeding orders as indicated in the MAR. These findings demonstrated that the facility did not implement the physician’s prescribed tube feeding volume as required by policy and the resident’s care plan. For a second resident with clear speech, memory deficits, cardiac arrest, respiratory failure, and swallowing difficulty, the MDS and nutrition care plan showed a PEG tube remained in place while the resident was on a mechanically altered diet and no longer receiving tube feeding. A nutritional evaluation documented that tube feeding had been discontinued after the resident established good appetite and oral intake. The resident’s representative notified the facility of the need for a physician referral to remove the PEG tube, and a PA progress note recorded that the resident reported discomfort from the PEG and that an order for removal was pending per nursing staff. During observation and interview, the resident stated they could manage nutrition by eating, no longer needed tube feeding, and wanted the PEG removed. However, review of medical records and progress notes over nearly two months showed no documented follow-up by the facility to coordinate PEG removal, and staff confirmed there was no documentation of follow-up after the PA’s visit, indicating a failure to ensure ongoing review and evaluation of PEG discontinuation once adequate oral nutrition was achieved.
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