Failure to Maintain Enhanced Barrier Precautions During Tube Feeding
Penalty
Summary
A deficiency was identified when staff failed to maintain enhanced barrier precautions (EBP) during the administration of tube feeding for a resident with a percutaneous gastrostomy tube. The resident, who had a history of stroke and was admitted with a feeding tube, was under EBP as indicated by signage outside her room and documented in her care plan. Despite these precautions, an LPN administered a bolus feeding without wearing a gown, contrary to facility policy and posted instructions. The LPN stated that EBP was only necessary for CNAs and not for nurses, as she believed she did not come into direct contact with the feeding tube. Further interviews revealed inconsistent understanding and application of EBP among staff. One RN reported that EBP was not used during tube feeding administration, while another LPN stated that both gown and gloves were required for such procedures. A CNA indicated that EBP did not apply to her as she did not administer tube feedings. The facility's policy specified that EBP, including gown and gloves, should be used during high-contact care involving indwelling medical devices such as feeding tubes. The failure to follow these precautions during tube feeding administration resulted in a deficiency related to infection prevention and control.
Plan Of Correction
1. The Infection Prevention Nurse provided one-to-one education on enhanced barrier precautions (EBP) with the resident's nurse. 2. All residents have the potential to be affected if they meet criteria for EBP. 3. Education will be provided to clinical employees related to EBP standard work. The following policies were updated to include verbiage related to using the appropriate personal protective equipment (PPE) as ordered, including EBP: Enteral Feeding, Indwelling Catheter, Peripherally Inserted Central Catheter Change, Irrigating Foley Catheter, Peripheral Intravenous Therapy Procedure, Male Straight Catheter, Female Straight Catheter, Care-Cleaning Urinary Drainage Bags, Pressure Injuries and Wound Care, Wound Culture. 4. Five weekly audits will be completed by the Infection Prevention Nurse or designee to ensure compliance with using EBP when appropriate, for the next 12 weeks. 5. The Executive Director is responsible for compliance.