HospitalInspections.org

Based on observation, record review, and interview, the nursing staff failed to ensure that medications were administered via a feeding tube in the correct position, and the care plan were was developed and kept current in one sampled patient (SP) #1.

The findings:


Review of the facility ' s literature titled, " Medication Administration: Feeding Tube, " dated 10/14, showed that patient's with feeding tubes should be placed in high-Fowler position (90 degrees) (if not contraindicated by medical condition) before and after the administration of medications.

Review of SP#1's Nutrition Notes dated 11/25/14 to 02/02/15 showed that the patient should be monitored for signs and symptoms of aspiration. Review of the patient ' s Plan of care did not show that aspiration was included in the patient's plan of care.

On 02/03/15 at 11:15 AM, Sampled Patient #1 was observed in the Intensive Care Unit. The patient was connected to a mechanical ventilator with a tracheostomy. The head of the bed was elevated to 15 degrees. The patient had a percutaneous endoscopic gastrostomy (PEG) tube (feeding tube) for bolus feeding and medications.

On 02/03/15 at 11:05 AM Staff A, Registered Nurse (RN), was observed giving medications to SP#1. SP#1 head of the bed was elevated at 15 degrees while Staff A administered the medications via the PEG tube.

On 02/03/15 at 11:10AM, Staff A stated that SP#1 liked to have the bed flat.

On 02/03/15 at 11:15AM, SP#1's mother stated that the staff lay the patient's bed flat at all times.

On 02/03/15 at 1:30PM Staff B, an RN stated the patient's head of the bed should always be elevated 30 to 45 degrees. She stated that when a patient with a feeding tube is given medications, the head of the bed should be elevated 30 to 45 degrees.

On 02/05/15 at 1:50 PM, Staff C, RN stated that a patient who is on a ventilator is placed on aspiration precautions. She stated that for patients on aspiration precautions, the head of the bed cannot be less than 30 degrees. She stated that if the patient is on a ventilator, the head of the bed should be at least 30 degrees at all times. She stated that aspiration precautions can be added to the plan of care.

Based on observation, record review, and interview, the nursing staff failed to ensure that medications are administered via a feeding tube, with the patient in the correct position, in one sampled patient (SP) #1.

The findings:

Review of the facility ' s literature titled, " Medication Administration: Feeding Tube, " dated 10/14, showed that patient ' s with feeding tubes should be placed in high-Fowler position (90 degrees) (if not contraindicated by medical condition) before and after the administration of medications.


On 02/03/15 at 11:15 AM, Sampled Patient #1 was observed in the Intensive Care Unit. The patient was connected to a mechanical ventilator with a tracheostomy. The head of the bed was elevated to 15 degrees. The patient had a percutaneous endoscopic gastrostomy (PEG) tube (feeding tube) for bolus feeding and medications.

Review of SP#1's Nutrition Notes dated 11/25/14 to 02/02/15 showed that the patient should be monitored for signs and symptoms of aspiration.


On 02/03/15 at 11:05 AM Staff A, Registered Nurse (RN), was observed giving medications to SP#1. SP#1 head of the bed was elevated at 15 degrees while Staff A administered the medications via the PEG tube.

On 02/03/15 at 11:10AM, Staff A stated that SP#1 liked to have the bed flat.

On 02/03/15 at 11:15AM, SP#1's mother stated that the staff lay the patient's bed flat at all times.

On 02/03/15 at 1:30PM Staff B, an RN stated the patient's head of the bed should always be elevated 30 to 45 degrees. She stated that when a patient with a feeding tube is given medications, the head of the bed should be elevated 30 to 45 degrees.

Based on observation and interview, the housekeeping staff H, failed to maintain a sanitary environment by failing to remove the isolation gown before leaving the work area (room 5010) per the facility's guidelines.


The findings:

Review of the facility's Exposure Control Plan titled, " [Named Hospital] Blood-borne Pathogens Exposure Control Plan", not dated, showed that all personal protective equipment shall be removed prior to leaving the work area. When personnel protective equipment is removed, it shall be placed in an appropriately designated area or container labeled for storage, washing decontamination or disposal.

An observation was made on 02/04/15 at 11:00 AM, while Staff H, a Housekeeping staff, was cleaning room 5010 on the fifth floor. Room 5010 had a contact isolation signs which stated that the patient was on Clostridium difficile (C-Diff) precautions. Staff H placed the cleaning cart in front of room 5010. She put gloves and gown on and entered the room. Staff H then cleaned the patient's furniture, toilet, and floor. After cleaning room 5010, Staff H left the patient's room wearing the gown and gloves and walked to the front of the cleaning cart which was located in the hallway.

On 02/04/15 at 11:10 AM, the Infection Control Officer stated that she saw that Staff H had worn the gown into the hallway after leaving the contact isolation room. She stated that Staff H should have removed the gown and gloves before leaving the patient's room.

On 02/05/15 at 1:50 PM, Staff C, Registered Nurse, stated that contact isolation gowns are removed before leaving the room. She stated that isolation gowns cannot be worn outside the patients' rooms.