Failure to Document and Implement Precautions for Resident with Respiratory MRSA
Penalty
Summary
The facility failed to ensure proper documentation and implementation of transmission-based precautions (TBP) and enhanced barrier precautions (EBP) for a resident diagnosed with respiratory MRSA. The resident, who was cognitively intact but dependent on staff for activities of daily living, had a history of diabetes, renal insufficiency, and COPD. After a positive sputum culture for MRSA and a course of antibiotics, there was no clear documentation in the medical record regarding when TBP were initiated or discontinued, nor the rationale for these decisions. Additionally, interventions and the use of PPE were not consistently documented or communicated to staff. Observations revealed that there was no signage for EBP or PPE available outside the resident's room, and the resident was seen coughing and spitting phlegm in a public area without covering his mouth. Interviews with staff indicated inconsistent use of PPE and confusion about the resident's precaution status. Some staff reported not wearing PPE in the week prior, and there was a lack of clarity on when precautions were to be started or stopped. The care plan was not updated to reflect TBP, and staff relied on informal communication methods rather than documented protocols. The facility's policies required contact precautions for MDROs like MRSA, with clear signage and documentation when precautions were implemented or discontinued. However, the infection control nurse and DON were unable to provide evidence of proper documentation or a clear process for discontinuing precautions. The medical director stated that precautions should remain until the infection was resolved, but was not involved in the decision to discontinue them. The lack of documentation, inconsistent communication, and failure to update the care plan contributed to the deficiency in infection prevention and control for the resident with respiratory MRSA.