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UPMC PRESBYTERIAN SHADYSIDE 200 LOTHROP STREET PITTSBURGH, PA 15213 Feb. 10, 2017
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on a review of facility documentation and medical records (MR), and staff interview (EMP), it was determined that the facility failed to ensure the registered nurse supervised and evaluated the care for each patient for five of six medical records reviewed (MR1, MR2, MR3, MR4 and MR6).

Findings include:

Review of the facility policy and procedure "Enteral Nutrition Administration" dated December 15, 2015, revealed " VI. Nutrition ... 8. All patients receiving enteral feedings should be assessed for intolerance every 4 hours..... Continuous/Intermittent... 8. Check gastric residual prior to feeding, and as ordered."

Review of facility documentation (attached to the physicians order for tube feedings) "Basic Tube Feeding Guidelines" revealed, "Check residuals every 4 hours in critically ill patients (ASPEN guidelines)."

1. Review of MR1 on February 9, 2017, revealed that the patient was ordered enteral tube feedings. Further review revealed the gastric residual was not checked on August 12, 2016, and on August 13, 2016, the residual was checked at 8:00 PM. Further review of MR1 revealed that on August 16 and 17, 2016, the residual was checked at 8:00 AM and 8:00 PM. The review of MR1 revealed that the residual was not checked every four hours as per facility policy and procedure, and as per the basic tube feeding guidelines.

Interview with EMP1 on February 9, 2017, at approximately 1:00 PM confirmed the above findings and revealed, "It [residual] is checked every 12 hours."

2. Review of MR2 on February 9, 2017, revealed that the patient was ordered enteral tube feedings. Further review revealed the gastric residual was checked on January 31, 2017, at 12:00 AM, 9:00 AM, and at 9:00PM. Further review of MR2 revealed that on February 1, 2017, the residual was checked at 9:00 AM and 7:17 PM, and on February 2, 2017, the residual was checked at 8:28 AM and 7:37 PM. There was no further documentation of a residual check until February 8, 2017. The review of MR2 revealed that the residual was not checked every four hours as per facility policy and procedure, and as per the basic tube feeding guidelines.

3. Review of MR3 on February 9, 2017, revealed that the patient was ordered enteral tube feedings. Further review revealed the gastric residual was checked on December 18, 2016, at 12:30 AM, 8:10 AM, and 8:00 PM, on December 19, 2016, at 8:00 AM, 11:56 AM, and 8:00 PM, and on December 20, 2016, the residual was checked at 1:04 AM, 8:00 AM, and 8:00 PM. . The review of MR3 revealed that the residual was not checked every four hours as per facility policy and procedure, and as per the basic tube feeding guidelines.

4. Review of MR4 on February 9, 2017, revealed that the patient was ordered enteral tube feedings. Further review revealed the gastric residual was checked on February 2, 2017, at 8:45 AM and 8:00 PM. The review of MR4 revealed that the residual was not checked every four hours as per facility policy and procedure, and as per the basic tube feeding guidelines.

5. Review of MR6 on February 9, 2017, revealed that the patient was ordered enteral tube feedings. Further review revealed the tube feeding was started on January 23, 2017, and the gastric residual was not checked until January 25, 2017, at 12:00 AM and 8:50 AM. There was no documentation of gastric residual being checked until January 27, 2017, at 7:30 AM and 8:30 PM. The review of MR6 revealed that the residual was not checked every four hours as per facility policy and procedure, and as per the basic tube feeding guidelines.