Surveyors on site--help with GTube Medications?!?

[santeeaholic]

With the new "Memo" sent out by CMS for clarification on GTube medications, and the Regulation still posted online conflicting what the update says, what is everyone doing as far as GTube meds go?

Online, the CMS regualtion states as of this morning on page 432 "While it is noted that some facility policies ideally adopt flushing the tube after each individual medication is given, as opposed to after the group of multiple medications is given, unless there are known compatibility problems between medicines being mixed together, a minimum of one flushing before and after giving the medications is all the surveyor need review. "

It is utterly rediculous to sepearte crushed meds that are mixed in water just to pour them down the same tube during the same administration time. Next they will be asking us to administer crushed meds PO seperately. They are going into the same stomach at the same time. What difference does it make if they are seperated or not as long as the meds are compatible?

What is everyone doing for this situation? We have surveyors in house at this very moment. So far going well but I highly anticipate a citation on this very topic.

Thanks!

[Kittypower123, BSN, RN]

Look up your facility's protocol and follow that. It doesn't matter what the regulation says. If you violate your facility policy, you will be cited. This happened at our facility when one of the nurses did not administer meds seperately and flush in between each as our policy states. In reality, it doesn't make any difference to the resident but violating policy during survey will result in a tag.

[cienurse]

Our policy and procedure tells us to instill 30cc of water after EACH medication and that's what DPH will be looking for-that you are following your facility's policy and procedure for medication administration via Gtube. What you described is a guidance to surveyors for observation, not an actual regulation. So, as long as you are following your facility's policyand procedure to the letter, you should be fine!

[santeeaholic]

Our facilty policy states flush with 30cc before medications are administered and 30 cc's after medications are administered. Nurses are following that policy. But I just have this nagging feeling in my gut the surveyors won't be happy with that.

Crossing my fingers, and my toes, as well as sending up lots of silent prayers!!

Thanks guys!

[CapeCodMermaid, RN]

I've done some research on this. The main reason for separating the meds is to know beyond a certainty which one was administered and which wasn't. At my last facility we had orders to crush all the meds, mix together and administer. We never had an issue with the DPH. But, you HAVE to follow your facility's policy.

[Blackcat99]

I have always been told that when the state is here that each medication must be given one med at a time-30cc of water before and after each med. Good luck.

[rose-n-arrows]

Some meds may form a precipitate when combined, possibly clogging the tubing. The facility where I work just completed a deficiency free survey. That's right, zero deficiencies! I invited the surveyors to observe me administering a feeding and med-pass via PEG tube.

For set up, I marked each cup with designated med, crushed med individually, and returned it to medpass cup.

I also marked each of two cups with 150 ml, and two with 60 ml indicator lines. I had a cup of lukewarm water ready to combine with each crushed med. Remember to have barriers on the bedside table. I used paper towels. Make sure the syringe, etc is properly dated.

1) Greet resident and ask whether they object to being observed

2) Place appropriate barrier (towel) on lap to catch spills

3) Listen for bowel tones, check placement, check residual, return residual

4) Proceed with feeding; our facility policy states 150 ml tepid water, then formula, followed by another 150 ml tepid water

5) Even though the tubing is clear of formula at this time, policy states to flush with 60ml water, followed by meds, one at a time, with 10ml water between each med. This resident had 7 meds. Then follow with another 60 ml water. Converse with the resident, as you should normally do anyway.

Clean up as per policy.

It seems llike it would take a while, but I do things the way I would do them if a surveyor were present, so it's easy. For this resident, crushing the meds individually probably took an extra minute or two compared to if I had crushed them all together. Hope this helps.

[santeeaholic]

DHEC has LEFT the building. We were deficiency free, second year in a row. WOO HOOO!!

Observation of a tube feeding med never occurred. I was blown away. They didn't want to see it because everything else went so well. Kinda proud of our nurses!!

However, I was told we should be following whatever our company policy states (off record by the survey team leader). That way, if there is a citation, the policy is cited and not the procedure making a plan of correction so much easier to accomplish.

Thanks everyone!!

[tokidoki7, ASN, RN]

How many patients with G-tubes do you guys usually administer medications to during your shift?

[Blackcat99]

We usually have 4-7 G-tube patients on each unit at my LTC.

[marghawk]

Not one of you mentioned how much water should go with each med prior pouring into tube, or how much between each med