HospitalInspections.org

Based on document review, medical record (MR) review and interview, in two (2) of two (2) MRs, the facility did not ensure nursing staff administered Synthroid [thyroid medication that must be taken on an empty stomach] via feeding tubes as per facility policy.

This placed patients at increased risk of not receiving therapeutic doses of the medication.

Findings include:

The facility Policy and Procedure (P&P) titled, "Enteral Tube Feeding," last reviewed 02/06/20, stated the following: ... "hold continuous tube feeding for medications that need to be administered on an empty stomach (eg. Synthroid...). If a patient is on a tube feeding, hold tube feeding for one hour before and two hours after administration of Synthroid... This will improve drug absorption and aid in maintaining therapeutic drug levels."

Patient #1's MR identified a physician's order dated 11/13/19 at 6:51PM, stated "Diabetes formula (1.2 calories at 20 cc/ml) start at 20 cc/hr via OGT [Orogastric Tube]" and at 7:01PM, "increase by 10 ml every 4 hours (goal rate 70)."
A physician's order dated 11/13/19 at 6:55 PM stated, "Synthroid 150 MCG=1 tablet OGT tube every day at 6:00 AM."

Review of the Critical Care Flow Sheets dated 11/14/19 - 11/17/19 and 12/03/19 - 12/20/19 identified the tube feeding was not held for one hour before and two hours after the administration of Synthroid, as per facility policy.

The same lack of not holding the tube feeding for one hour before and/or two hours after Synthroid administration was also identified in Patient #10's MR for review periods 04/30/19 - 05/02/19; 05/05/19 - 05/15/19; 05/17/19 - 05/25/19, and 05/27/19 - 05/30/19.

During interview of Staff C (Assistant Director of Nursing Quality) on 07/02/21 at 10:30AM, Staff C confirmed these findings and could not offer a reason why the staff was not following the facility policy.