Failure to Implement Enhanced Barrier Precautions for Resident with Dialysis Catheter
Penalty
Summary
The facility failed to implement appropriate enhanced barrier transmission-based precautions for a resident with a tunneled dialysis catheter, as required by the facility's infection prevention and control program. The deficiency was identified during an observation and review of clinical records, which revealed that the resident was not on enhanced barrier precautions (EBP) despite having a medical device that necessitates such precautions. The facility's policy, aligned with CDC guidelines, mandates the use of EBP for residents with indwelling medical devices during high-contact care activities to prevent the spread of multi-drug resistant organisms. The resident in question had a current physician's order for hemodialysis and a tunneled dialysis catheter placed in the right chest, as documented in both hospital and nursing records. However, there was no evidence in the clinical record or during the observation that EBP were being implemented for this resident. Specifically, there were no signs indicating EBP precautions, no personal protective equipment available in the room or at the doorway, and no instructions for staff to consult the nurse prior to providing care. An interview with the Nursing Home Administrator confirmed that the resident was not on EBP, contrary to the facility's policy. This oversight was noted as a deficiency in the facility's infection prevention and control practices, which had been previously cited in an earlier survey. The failure to adhere to the established infection control protocols for residents with indwelling medical devices represents a lapse in maintaining a safe and sanitary environment as required by federal regulations.
Plan Of Correction
1. Resident 75 was immediately placed on Enhanced Barrier Precautions with isolation set up. 2. The Director of Nursing and IP reviewed all residents in need of EBP to ensure they had the proper isolation signage and set up. 3. The Director of Nursing completed an education with the nursing department to ensure EBP is in place for any residents who are contraindicated for Enhanced Barrier Precautions. 4. The Director of Nursing or designee will complete weekly random audits for four weeks, then monthly for four months, and bring the EBP audits to the monthly QA meeting for review.