Failure to Implement Enhanced Barrier Precautions for Resident with Wound
Penalty
Summary
The facility failed to consistently implement its policy for enhanced barrier precautions (EBP) for a resident with a wound requiring such precautions. Multiple observations over several days showed that the resident, who had an arterial wound on his right foot and was under orders for EBP, did not have the required signage for transmission-based precautions on his door. Additionally, the necessary bins for disposal of personal protective equipment (PPE), trash, and laundry were not present in the resident's room until after the deficiency was identified. Staff interviews revealed that certified nursing assistants (CNAs) relied on door signage and assignment sheets to identify residents on EBP, but the resident in question was not listed or marked appropriately, leading to confusion about his precaution status. The resident had significant medical conditions, including chronic diastolic heart failure, peripheral vascular disease, multiple myeloma, and a protein calorie deficit, and required substantial staff assistance for daily activities. Despite care plans and physician orders indicating the need for EBP due to his wound, the infection preventionist had not placed the required signage, and staff were unaware of the resident's EBP status. The facility's policy, revised in December 2022, required proper signage and receptacles for EBP, but these measures were not implemented as ordered for this resident.