Failure to Update Care Plans for Infection Control Precautions
Penalty
Summary
The facility failed to develop and implement person-centered, comprehensive care plans with measurable objectives and timeframes for two residents who required specific infection control precautions. For one resident with an indwelling Foley catheter, the care plan did not include the need and physician order for Enhanced Barrier Precautions (EBP), despite the presence of an EBP sign outside the resident's room and a physician order for EBP. For another resident with a diagnosis of C. Diff, the care plan did not reflect the need and physician order for Contact Precautions, even though a Contact Isolation sign was posted and an order for Contact Precautions was present in the medical record. Interviews with staff revealed that certified nursing assistants (CNAs) and nurses did not routinely use or access care plans to guide resident care, relying instead on other tools such as the Kardex. The registered nurse (RN) and director of nursing (DON) both acknowledged that care plans should have included the required precautions and that staff should have known how to access and use them. The minimum data set (MDS) nurse, responsible for updating care plans, admitted that the care plans for these two residents were overlooked due to a recent gastrointestinal outbreak and other competing priorities, despite being aware of the need for updates. Facility policy required that care plans incorporate goals and objectives to achieve the resident's highest level of independence and that the interdisciplinary team (IDT) develop comprehensive, person-centered care plans based on resident assessments. However, the care plans for these two residents were not updated to reflect current infection control needs, as required by policy and physician orders.