§483.25(g)(4)-(5) Enteral Nutrition (Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-
§483.25(g)(4) A resident who has been able to eat enough alone or with assistance is not fed by enteral methods unless the resident's clinical condition demonstrates that enteral feeding was clinically indicated and consented to by the resident; and
§483.25(g)(5) A resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers.
|
Observations:
Based on review of clinical records, facility policy, and staff interview, it was determined that the facility failed to obtain physician admission orders for one of three residents (Resident R).
Review of the facility policy "Resident Rights" dated 10/17/23, indicate to provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the residents. Review of the facility policy "Enteral General Nutrition (tube feeding) guidelines" indicate to verify physician orders for type of enteral formula, amount, frequency, flush volume, and method of delivery. Review of Resident R1 clinical records indicated readmission to facility on 1/23/2024, with the diagnosis of osteomyelitis (infection of bone), pressure ulcer of sacral area (bone at bottom of spine) stage four (deep wound that may impact muscle, tendon, ligaments, and bone) gastrostomy status (surgical procedure that creates an artificial external opening into the stomach for nutritional support). Review of hospital discharge summary of care indicated Gastrostomy Tube (G-tube) placed on January 1/19/24, started on Jevity (formula type) tube feedings as per nutrition service. G-tube dislodged on 1/20/24, repeat tube placement completed on 1/22/24, tube is ready for use. Continue feeding to optimize wound healing.
Review of nursing admission evaluation 1/23/24, indicated readmission to facility G-tube inserted 1/22/24.
Review of physician orders dated 1/27/24, 11:00 p.m. Enteral Feed every night shift for start at 11:00 p.m. ends at 7:00 a.m. Formula: Jevity 1.5 ml via Peg Tube, 50 cc/hr, with flush of 100cc every 4 hours.
Interview 2/15/24, 3:34 p.m. Regional Clinical Director of Operations, Employee E1 confirmed Resident R1's tube feeding was not initiated upon readmission to facility, records indicate feeding orders obtained 1/27/24.
Interview 2/15/23, 3:34 p.m .Regional Clinical Director of Operations, Employee E1 confirmed the facility failed to obtain physician orders upon readmission to facility for one of three residents.
28 Pa. Code: 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(e)(1) Management. 28 Pa. Code 211.11(d) Resident care policies. 28 Pa. Code 201.29(d) Resident Rights 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services
| | Plan of Correction - To be completed: 03/29/2024
Resident R1 is no longer a resident at the facility. Order for enteral feeding obtained on 1/27/24.
Upon Admission, DON or designee will ensure admission orders are verified by provider within 1 hour of arrival
By 3/29/24, DON or designee will provide education to nursing staff regarding admission procedures and verifying physician orders.
By 3/29/24, DON or designee will conduct audits of all admission orders for enteral feedings 5 times per week for 2 weeks, then 3 times per week for 2 weeks. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendation until substantial compliance is maintained.
|
|