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Based on medical record review, staff interview and policy review, the hospital failed to ensure the nurse documented evidence of a continuous tube feed infusion on two days for one of fifteen medical records reviewed (Patient #2). The active census was 101.

Findings include:

Review of Policy and Procedure Number: G-01-N (Revised 01/01/18) for Gastric/Duodoenal Tube Guidelines: PEG, Gastrostomy Tube, Small -Bore Nasal Tube, Nasogastric Tube, Orogastric stated the guidelines for maintaining a continuous enteral feeding should include tubes being checked for placement before initiating feeding or medication administration by assessing tube tube level and length and by observing the patient for gastrointestinal assessment. Documentation should include residuals, the time the feeding was initiated, the type of formula used, the rate of the pump, patient tolerance, that the patient's head of bed was elevated, site and mouth care, and intake and outputs.

Review of the medical record for Patient #2 revealed the patient was transferred from a local hospital intensive care unit on 12/06/17. The patient was admitted for continued intravenous antimicrobials, management of nasogastric tube for tube feeds, dialysis and rehabilitation. The patient had a nasogastric tube (NG) in place and was receiving total parental nutrition via a tube feed. Physician orders on admission revealed the patient was to be NPO (nothing by mouth) with continuous tube feeds. On 12/07/17 physician orders included Promote with Fiber at 50 milliliters(ml)/hour which was discontinued on 12/08/17 when a new order for Glucerna 20 ml/hour with an increase of 5 ml over 8 hours to reach a goal of 45 ml/hr was received. The patient developed loose stools and the tube feed order was changed on 12/09/17 to Nepro 20 ml/hour with an increase of 5 ml over 12 hours to reach a goal of 45 ml/hr.

Review of the daily flowsheets revealed no nursing documentation on 12/08/17 and 12/10/17 of the tube feed running as ordered by the physician.

The finding was confirmed in an interview with Staff A on 03/01/18 at 10:05 AM.

This substantiates substantial allegation OH00095951.