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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 5 of 5 patients who received nutrition via a feeding tube (#P1, P2, P3, P4, and P5).

Findings included:

1. The facility policy "Enteral Tube Feedings: Continuous and Intermittent Feeding", last revised 04/2013, indicated, "Additional Nursing Responsibilities related to enteral feeding: 1. Tube placement must be evaluated with each assessment, medication or feeding administration.... 2. Residual must be checked before any feeding/medication administration if tube type allows. If residual greater than twice the feeding rate, medical provider must be notified. 3. Head of bed should be at least 30 degrees elevation at all times while feedings are infusing. 4. Tube should be flushed with 30 ml. [milliliters] of water a minimum of every 6 hours to ensure patency."

2. The medical record for patient #P1, who was admitted 06/11/13 and transferred to an acute care facility on 06/22/13, and who received continuous feeding via a SBFT, was reviewed. The Care/Assessment Flow Sheets were reviewed and the following documentation regarding the tube feedings indicated: on 06/12/13 Meds/flush four times with no residual checks, on 06/13/13 Meds/flush five times with residual checks two times, on 06/14/13 Meds/flush four times with residual checks four times, on 06/15/13 Meds/flush four times with residual checks one time, on 06/16/13 Meds/flush five times with residual checks four times, on 06/17/13 Meds/flush five times with residual checks three times, on 06/18/13 Meds/flush six times with residual checks two times, on 06/19/13 Meds/flush six times with no residual checks, on 06/20/13 Meds/flush four times with residual checks three times, and on 06/21/13 Meds/flush six times with residual checks seven times.

3. The medical record for patient #P2, who was admitted 06/11/13 and transferred to a rehab facility on 07/08/13, and who received continuous feeding via a SBFT, was reviewed. Five random, consecutive days of Care/Assessment Flow Sheets were reviewed and the following documentation regarding the tube feedings indicated: on 06/14/13 Meds/flush five times with residual checks two times, on 06/15/13 Meds/flush four times with no residual checks, on 06/16/13 Meds/flush six times with residual checks two times, on 06/17/13 Meds/flush three times with residual checks two times, and on 06/18/13 Meds/flush three times with residual checks three times.

4. The medical record for patient #P3, who was admitted 05/21/13 and expired on 06/26/13, and who received continuous feeding via a SBFT, was reviewed. Five random, consecutive days of Care/Assessment Flow Sheets were reviewed and the following documentation regarding the tube feedings indicated: on 05/21/13 Meds/flush four times with residual checks two times, on 05/22/13 Meds/flush one time with residual checks one time, on 05/23/13 Meds/flush one time with residual checks one time, on 05/24/13 Meds/flush three times no residual checks, and on 05/25/13 Meds/flush five times with residual checks three times.

5. The medical record for patient #P4, who was admitted 05/31/13 and transferred to a rehab facility on 08/07/13, and who received continuous feeding via a PEG tube, was reviewed. Five random, consecutive days of Care/Assessment Flow Sheets were reviewed and the following documentation regarding the tube feedings indicated: on 06/02/13 Meds/flush four times with residual checks one time, on 06/03/13 Meds/flush five times with residual checks two times, on 06/04/13 Meds/flush four times with residual checks one time, on 06/05/13 Meds/flush three times with residual checks two times, and on 06/06/13 Meds/flush three times with residual checks one time.

6. The medical record for patient #P5, who was admitted 05/15/13 and transferred to a skilled nursing facility on 07/10/13, and who received continuous tube feeding, was reviewed. Five random, consecutive days of Care/Assessment Flow Sheets were reviewed and the following documentation regarding the tube feedings indicated: on 05/16/13 Meds/flush three times with residual checks two times, on 05/17/13 Meds/flush four times with residual checks one time, on 05/18/13 Meds/flush four times with residual checks three times, on 05/19/13 Meds/flush two times with residual checks one time, and on 05/20/13 Meds/flush five times with residual checks two times.

7. At 1:30 PM on 08/28/13, staff member #N4 indicated nursing staff indicated the feeding tube practice was to check residuals twice a shift and with each medication administered.

8. At 3:25 PM, staff member #N7 confirmed the tube feeding residual check practice and also confirmed the lack of documentation.

9. 4:30 PM on 08/28/13, staff member #N6 confirmed the medical record findings and lack of documentation of feeding tube checks.