Failure to Post Enhanced Barrier Precaution Signage for Resident with Chronic Wound
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program for a resident who was ordered to be on enhanced barrier precautions due to chronic wounds. The resident, a male with multiple diagnoses including atherosclerotic heart disease, peripheral vascular disease, chronic venous hypertension with ulcer, chronic kidney disease, and hemiplegia, was dependent on staff for all activities of daily living and had a venous ulcer present. Physician orders and the care plan specified the need for enhanced barrier precautions, including the use of gowns and gloves during high-contact personal care activities. Despite these orders, observations on multiple occasions revealed that there was no enhanced barrier precaution sign on the resident's door, which is required to alert staff to the need for personal protective equipment (PPE) when providing care. Interviews with nursing staff and CNAs indicated that they believed the resident had a sign on the door and that such signage was standard practice for residents on enhanced barrier precautions. However, direct observation by surveyors confirmed the absence of the required signage during the survey period. The facility's policy and staff training materials indicated that signs should be posted on the door or wall outside the resident's room to indicate the type of precautions and PPE required. The lack of signage was confirmed by both the Director of Nursing and the Administrator, who acknowledged the importance of the sign for infection prevention and staff compliance. The deficiency was identified through record review, staff interviews, and direct observation.