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Based on record review, policy review and interviews it was determined the nursing department failed to have a policy and procedure for nasal gastric tubes (NGT) to ensure proper placement for 1 (#5) of 9 records sampled.

Findings include:

1. Patient #5's physician order dated 12/28/2013 indicated for a NGT to be inserted to start tube feedings.
The nursing notes document the nurse attempted to insert the NGT unsuccessfully. On 02/28/2014 at 2:00 p.m. the nursing notes document the nursing supervisor inserted the NGT with gastric contents seen in tube and air sound in stomach.

The nurse documents at 5:10 p.m. the NGT placement was checked with another nurse and air sound was heard. On 02/28/2014 at 5:20 p.m. the nurse documented the patient had respiratory distress and was vomiting yellowish fluids after being medicated and the tube feeding started. The nursing notes document Respiratory Therapy was in the process of intubating the patient and reported seeing the NGT in the lung and pulled NGT out.

The rapid response team documentation dated 12/28/2013 at 6:05 p.m. document the patient was in respiratory distress with oxygen saturation levels in the low 80s and the patient had just been started on tube feedings. The assessment reads "During intubation via glidescope NGT [was] noted in [the]Trachea [and was] immediately discontinued".

An interview with the chief nursing officer and director of risk management on 02/19/2014 at approximately 12:00 p.m. revealed there are no facility policies and procedures specific to nasal gastric tubes (NGT) placement or assessment of placement.