cms_AZ: 75
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 75 | HAVEN OF SCOTTSDALE | 35059 | 3293 NORTH DRINKWATER BOULEVARD | SCOTTSDALE | AZ | 85251 | 2017-10-25 | 322 | D | 0 | 1 | DB1811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, staff interviews and policy review, the facility failed to ensure one resident (#83) with a feeding tube was provided the appropriate treatment and services. Findings include: Resident #83 was admitted on (MONTH) 1, (YEAR) and readmitted on (MONTH) 19, (YEAR), with [DIAGNOSES REDACTED]. Review of the clinical record revealed the resident had a percutaneous endoscopic gastrostomy (PEG) tube. A care plan dated (MONTH) 5, (YEAR) included the resident had a feeding tube related to poor nutritional intake. A goal included the resident would be free of aspiration. Interventions were for the nurse to check tube placement per facility protocol, and flush the PEG tube with water. Review of a Minimum Data Set (MDS) assessment dated (MONTH) 9, (YEAR) revealed the resident had severe cognitive impairment, was unable to speak, and had a feeding tube. A medication administration observation was conducted on (MONTH) 23, (YEAR) at 9:00 a.m., with a Registered Nurse (staff #4). During the observation, the nurse crushed nine medications together and mixed them with 60 cc of water in a cup. Without first checking placement of the PEG tube, the nurse then flushed the resident's PEG tube with 30 cc of water using a 60 cc syringe, by pushing the plunger on the syringe to administer the water, instead of using the gravity flow method. The nurse then drew up the medications which had been mixed with water into the syringe, and pushed the plunger on the syringe to administer the medications into the PEG tube, instead of using the gravity flow method. Next, the nurse flushed the PEG tube with 30 cc of water using a 60 cc syringe and pushed the plunger on the syringe to administer the water, instead of using the gravity flow method. Following the observation, an interview was conducted with staff #4, who stated that she had checked the placement of the tube by looking at a black line on the PEG tube. She stated that if the line is not visible, the PEG tube is not correctly placed and the tube cannot be used. Staff #4 stated that she did not need to use a stethoscope to check for correct placement of the tube, because the night shift nurse does that. Staff #4 also stated that the medications are usually pushed into the tube by depressing the plunger on the 60 cc syringe, and she was not sure if the gravity flow method was suppose to be use. She stated that she had mixed all of the medications together in the same cup, instead of giving them separately to prevent the resident from being disturbed. Staff #4 further stated that she was unsure what the facility policies were regarding medication administration through a PEG tube. An interview was conducted on (MONTH) 24, (YEAR) at 11:00 a.m., with the Director of Nursing (DON/staff #5). The DON stated that nurses are supposed to check the placement of the PEG tube, prior to flushing the tube. Staff #5 stated that this is done by injecting air into the tube, and at the same time, using a stethoscope to listen for air being injected into the stomach. The DON stated that the medications provided through a PEG tube are to be given separately and should not be mixed altogether. The DON further stated the nurses are supposed to remove the plunger from the 60 cc syringe, add the crushed medications which have been mixed with water, and allow the medications to flow by gravity into the PEG tube. The DON stated the nurses are not to administer the medications by depressing the plunger on the syringe. A facility policy for administering medications through an enteral (PEG) tube contained the following guidelines: The nurse is not to mix medications together prior to administering medications through an enteral tube, the nurse is to administer each medication separately; the nurse is to confirm placement of the feeding tube prior to flushing the tube; and that medications are to be administered by gravity flow. | 2020-09-01 |