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Based on observation, interview and record review, the facility failed to administer medications through a feeding tube by using professional Standards of Practice for 2 (#1, #12) of 2 patients observed for Medication Pass.


The findings include:


1. On 7/29/15 at 8:28am, Staff H was observed passing medications to Patient #11. The patient had orders to receive Certavite 15 ml and Psyllium 5 Grams 1 packet through the Nasogastric Tube (NGT). The staff nurse assessed and checked the patency and placement of the NGT. Staff Nurse H pulled up the Certavite 15 ml in the piston syrine and injected directly into the NGT. The Certavite and flush were not allowed to flow through the tube by gravity. The staff nurse mixed the Psyllium in approximately 60 cc's of water and pulled up the Psyllium solution into the piston syringe. She attempted to inject the Psyllium directly into the NGT a few times, and it would not go through the tube. The staff nurse did not allow the solution to flow by gravity. She then dumped the solution from the piston syringe back into the plastic cup. She attempted to flush with some water, but it would not go through the tube. She pushed and pushed, but it would not go through the tube. The nurse was asked to stop pushing solution through the tube, as it was blocked. The staff nurse was asked, "Is there resistance in the tube?" She stated, 'Yes'. The nurse went to her medication cart and obtained a PEG Tube brush to clean the tube that did not work. The Chief Clinical Officer (CCO), who was in the room, agreed that the nurse should stop pushing the medication through the tube. The CCO told the nurse that she would need to change the tube.


2. During Medication Pass observation on 7/29/15 at 10:02am, Staff Nurse I was observed passing medications to Patient #12. Patient #12 had a Gastrostomy tube. There were orders for the patient to receive several medications that required crushing. The nurse crushed each medication and walked back and forth to the sink each time, to obtain water to mix and administer each medication. The medications included Amlodipine 10 mg; Lactobacillus Acidohilis; Tylenol 650 mg; Carvedilol 25 mg; Aspirin 81 mg; Ferrous Sulfate Elixir 300 mg; Levetriacetam 500mg; Ticagrelor 90 mg; ascorbic acid 500 mg and protein supplement.


Staff Nurse I injected each medication and water flush directly into the GT without allowing each medication and water flush to be administered by gravity. The entire Medication Pass took approximately 55 minutes to complete.


Review of the policy and procedures for Medication Administration via Feeding Tube revealed the policy and procedures did not address how staff should administer the medications through a feeding tube.


Review of the Lippincott Manual of Nursing Practice revealed the tube is flushed with 30 cc's of water to flush the tube. The syringe is attached to the end of the tube. The medication is poured into the syringe. If the medication flows smoothly, slowly add more until the entire dose has been given. If the medications doesn't flow properly, don't force it; instead, raise the syringe slightly. If it's too thick, dilute it with additional water.


Interview with the CCO on 7/29/15 at 10:59am revealed staff should use gravity to administer medications through the feeding tube.