Failure to Update Care Plans for Residents on Contact Isolation
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for two residents who required contact isolation due to infections with ESBL and MRSA. For one resident with a history of urinary tract infection, diabetes, stroke, and severe cognitive impairment, a urinalysis revealed ESBL, and physician orders were in place for both antibiotics and contact isolation. However, the resident's care plan only addressed the UTI and did not include any interventions or objectives related to contact isolation for ESBL, despite visible isolation signage and orders in the medical record. For another resident with dementia, UTI, anxiety, and cognitive intactness, a urinalysis detected MRSA, and physician orders included antibiotics and contact isolation. The care plan did not address the need for contact isolation or the resident's refusal to comply with isolation protocols, as the resident was observed participating in group activities outside her room while on contact precautions. The care plan was only updated after surveyor intervention to include isolation measures. Interviews with facility staff, including the ADON, DON, Regional MDS nurse, and Administrator, revealed that care plan updates were the responsibility of the MDS nurses and management team, and that changes such as new orders should be reflected in the care plan within 24-48 hours. However, staff acknowledged that the care plans for these residents had not been updated to reflect the new isolation requirements or behavioral issues related to isolation refusal, despite being aware of the orders and discussing resident changes in daily meetings.