A resident with a PEG tube, dysphagia, and a history of cerebral infarction was ordered to receive bolus Glucerna 1.5 feedings during the day and continuous feedings overnight. During observation, the resident was receiving only continuous feeding, and an LPN confirmed she did not give the ordered daytime bolus feedings because she believed the order was for continuous feeding 24/7. The DON confirmed the resident should have received the enteral feedings as ordered by the MD.
Enteral feeding care was not provided as ordered for two residents. One resident’s free water bag remained in use beyond the 24-hour limit, and staff confirmed it should have been changed sooner. Another resident with a PEG tube did not receive ordered 100 mL water flushes every 4 hours because staff said the resident was out of the room, and an LPN later gave the first flush of the day.
Incorrect Enteral Water Flush Rate: A resident with a gastrostomy status had a physician order for continuous enteral feeding with 275 mL water flushes every 4 hours, but observations showed the pump infusing flushes at 200 mL every 4 hours. An LPN confirmed the incorrect rate, and the DON later verified the ordered flush amount was not being followed.
Incorrect Free Water Flush Rates for Two Residents with Feeding Tubes: The facility failed to provide ordered free water flushes for two residents with gastrostomy tubes. Both residents had physician orders for 40 mL/hr flushes, but observations showed the tube feeding pumps infusing at 30 mL/hr. An LPN stated the flushes should be 30 mL/hr, while the DON confirmed the ordered rate was 40 mL/hr.
A resident with a gastrostomy tube had continuous enteral feeding ordered, but the feeding pump was observed showing an inactive error and not infusing during multiple checks. An LPN stated the tube feeding had likely been paused for hours and confirmed it should not have been stopped that long; the DON confirmed tube feedings should be given at the ordered rate.
A resident with an order for Glucerna 1.2 at a specified rate and duration was instead observed receiving Isosource at 60 ml/hour. Record review confirmed the physician’s order for Glucerna 1.2, while observation and interview with an LPN verified that Isosource, a different enteral formula, was being administered. The DON later stated that the LPN should have verified the physician’s order before administering the tube feeding.
A resident with dysphagia, severe protein calorie malnutrition, and a gastrostomy had an enteral feeding order requiring the formula container, syringe, and administration set to be labeled with the resident's name, date, time, and nurse's initials. During observation, the tube feeding bag had no label, and an LPN confirmed it should have been labeled.
A resident with a gastrostomy and post-cerebral infarction dysphagia had physician orders for continuous Jevity 1.5 at 70 ml/hr with 170 ml water flush every four hours, but surveyors twice observed the feeding infusing at 50 ml/hr with 165 ml flushes every five hours. The same tube feeding bag, labeled as started the previous day, remained in use beyond 24 hours. An LPN confirmed the feed and flushes were not administered per orders and that the bag should have been changed after 24 hours, and the ADON acknowledged that facility practice requires tube feeding and water bags to be changed every 24 hours and that nurses are expected to follow the ordered rates.
A resident with an enteral tube had an active order for Diabetisource at 45 mL/hr with a 200 mL water flush every hour, but observations showed the pump was set to give a 150 mL water flush every 4 hours instead. An LPN confirmed the pump settings did not match the physician's order, and the DON acknowledged the ordered flush was not being administered as prescribed.
A resident receiving continuous enteral feeding had a tube feeding bag observed without the resident’s name, date, time, or infusion rate documented, despite the facility policy requiring labeling of the container. The resident had a gastrostomy and diagnoses including CVA, hemiplegia, aphasia, and dysphagia; an LPN and the DON both confirmed the bag was unlabeled and should have been labeled.
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