Failure to Date Medical Equipment and Adhere to PPE Protocols During Resident Care
Penalty
Summary
The facility failed to ensure proper infection prevention and control practices in several instances. For one resident receiving oxygen therapy, the nasal cannula oxygen tubing was not labeled with a date, contrary to facility protocol which requires tubing to be dated and replaced regularly. The Infection Preventionist Nurse confirmed that the tubing was undated and stated that dating is necessary for staff to know when to replace it, as part of infection prevention measures. In another case, a resident with an indwelling urinary catheter system did not have the catheter tubing and urine collection bag labeled with the date, time, and initials at the time of placement. The Licensed Vocational Nurse acknowledged the omission and explained that proper labeling is important to track when the catheter and bag were last changed, in accordance with physician orders and facility policy. The Director of Nursing also confirmed that the equipment should have been dated and initialed at the time of placement. Additionally, a Certified Nurse Assistant was observed providing urinary catheter care to a resident on enhanced barrier precautions without donning an isolation gown, as required by the facility's policy for residents with indwelling medical devices. The CNA admitted to forgetting to wear the gown and recognized the importance of following enhanced barrier precautions to reduce the risk of infection. Facility policy and signage were in place to remind staff of the required personal protective equipment for such care activities.