HospitalInspections.org

Based on policy review, medical record review, and interview, the registered nurse failed to ensure care was provided according to policy regarding enteral tube feedings for 4 of 4 patients who received nutrition via a gastrostomy tube (#P1, P2, P3, and P4).

Findings included:

1. The facility policy "Enteral Nutrition, Provision of", last reviewed 08/20/12, indicated, "All patients with gastrostomy and jejunostomy feeding tubes will have skin care given at 12-hour intervals or more frequently as ordered by the physician or necessitated by patient condition. ...Procedure: ...C. Inspect surrounding skin for redness, tenderness, induration, swelling, irritation, purulent drainage, or gastric leakage. ...D. Gently cleanse the stoma site skin with soap and water (or as ordered by the physician). ...E. Dry thoroughly. Leave area open to air to minimize dampness, skin irritation, and maceration. ...K. Document as follows: date and time of site care; condition of stoma site and surrounding skin; centimeter marking of skin disc; drainage present and changes in dressing or drain; patient tolerance to procedure. ...Gastrostomy Tube Feeding: ...E. Check the amount of residual gastric contents (with a 60-ml syringe) before each intermittent feeding or approximately every 3-4 hours during continuous feeding. ...I. Document residuals, tolerance and volume of feeding in appropriate pathway."

2. The medical record for patient #P1, who received continuous feeding via a PEG (Percutaneous Endoscopic Gastrostomy) tube, was reviewed for the dates of 03/10/13 through 03/14/13. The record lacked documentation of skin care every 12-hours, condition of stoma and surrounding skin, and centimeter marking of skin disc. The form "24 Hour Patient Record" lacked documentation of gastric residuals for 0100 and 0500 on 03/10/13, 0100, 0500, and 2100 on 03/11/13, 0100 and 0500 on 03/12/13, and 0900 and 1300 on 03/14/13.

3. The medical record for patient #P2, who received continuous feeding via a gastrostomy tube, was reviewed for the dates of 03/11/13 through 03/14/13. The record lacked documentation of skin care every 12-hours, condition of stoma and surrounding skin, and centimeter marking of skin disc. The form "24 Hour Patient Record" lacked documentation of gastric residuals for 0100, 0500, and 2100 on 03/11/13, 0100, 0500, 1300, 1700, and 2100 on 03/12/13, 0100, 0500, and 2100 on 03/13/13, and 0100, 0500, and 2100 on 03/14/13.

4. The medical record for patient #P3, who received continuous feeding via a PEG tube, was reviewed for the dates of 03/11/13 through 03/13/13. The record lacked documentation of skin care every 12-hours, condition of stoma and surrounding skin, and centimeter marking of skin disc. The form "24 Hour Patient Record" lacked documentation of gastric residuals for 0900, 1300, and 1700 on 03/11/13, 0100, 0500, 0900, 1300, 1700, and 2100 on 03/12/13, and 0100, 0500, 0900, 1300, 1700, and 2100 on 03/13/13.

5. The medical record for patient #P4, who received continuous feeding for 18 out of 24 hours via a PEG tube, was reviewed for the dates of 03/11/13 through 03/14/13. The record lacked documentation of skin care every 12-hours, condition of stoma and surrounding skin, and centimeter marking of skin disc. The form "24 Hour Patient Record" lacked documentation of gastric residuals for 0900, 1300, 1700, and 2100 on 03/11/13, 2100 on 03/12/13, 0900, 1300, 1700, and 2100 on 03/13/13, and 0900, 1300, 1700, and 2100 on 03/14/13.

6. At 11:50 AM on 06/06/13, staff member #N4 indicated the facility began using new pumps for enteral feedings a few months ago. The pumps had a stop-cock device so the tubing didn't need to be disconnected to check residuals and give medications. He/she indicated the residuals should be checked prior to medication administration, but at least every 4 hours.

7. At 4:40 PM on 06/06/13, staff member #N2 confirmed the medical record findings and also confirmed medical record documentation failed to ensure the gastrostomy tube care was provided according to policy. He/she indicated there were no complaints/grievances regarding any of the patients reviewed.



.