IDPH has cited and fined Burgess Square Health Center nursing home in Westmont after a resident there was given tube feedings well in excess of that ordered by the physician, causing her to experience acute congestive heart failure and requiring hospitalization.
One of the basic functions of nurses in a nursing home setting is to provide care in accordance with physician orders. Each resident will have a diet order. Some residents have an order for a general diet, other residents have a modified diet such as a mechanical soft diet which is intended to reduce the risk of nursing home choking accidents. Still other residents receive their nutrition through tube feedings, and this is something which requires the help of the nursing staff.
When a resident receives nutrition through a feeding tube, the order will usually include what kind of formula should be given and how much. Failing to give the right kind of formula can cause medical problems for the resident, while failing to give as much as ordered can lead to malnutrition and other illnesses for the resident. Here, we have a situation where the resident was given far more than ordered.
The order that was in place called for the resident to receive a 275 ml of formula three times a day. Typically, that amount would be given over two to three hour period. Instead of providing the tube feeding as ordered, the nurse gave the resident 275 ml of formula per hour for five hours. This means that the resident received a far greater amount than was ordered, far faster than was ordered.
The net result of this was that the resident experienced fluid overload which led to acute congestive heart failure. The resident experienced severe abdominal pain from overfeeding. She also experienced significantly elevated blood sugars. All of this led to an unnecessary hospitalization for her.
The root cause of this feeding tube accident was that the order was not followed. The order was for a 275 ml bolus (single dose), rather than 275 ml per hour continuously. In much the same way that medication errors in nursing homes can be prevented by making the proper checks, this incident could have been easily avoided by checking the physician order before administering the tube feedings.
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