Failure to Meet Professional Standards During Scabies Outbreak
Penalty
Summary
The facility failed to ensure that services provided met professional standards of quality during a scabies outbreak, specifically in the care of one resident with severe cognitive impairment and multiple comorbidities. The resident experienced ongoing skin issues, including excoriations and rashes, over several months. Initial treatments included topical steroids and permethrin cream, but documentation shows that the recommended two treatments of permethrin were not consistently administered, and the resident continued to experience symptoms. The outbreak was widespread, affecting multiple residents, and the facility's outbreak tracking indicated a significant number of cases. There were lapses in the diagnostic process for scabies. Skin scrapings to test for scabies were performed by licensed nurses who were not trained in the procedure and did not have physician orders to do so. The Infection Preventionist and DON confirmed that licensed nurses were not trained or authorized to perform skin scrapings, and the Medical Director stated that only trained professionals should conduct such tests, with samples sent to a laboratory for confirmation. Despite ongoing symptoms and repeated documentation of rashes and itching, there were delays in obtaining a dermatology consult and in confirming the diagnosis of scabies. The facility's Infection Control Program, as outlined in the job description, required the Infection Preventionist to coordinate and direct infection control measures, including ensuring proper isolation and precautions for residents with communicable diseases. However, the lack of training for staff on scabies identification and testing, as well as the failure to follow best practices for treatment and diagnosis, contributed to the prolonged outbreak and inadequate care for affected residents.