Failure to Implement Enhanced Barrier Precautions During Resident Care
Penalty
Summary
During a complaint investigation, it was observed that two nurse aides entered the room of a resident who was under Enhanced Barrier Precautions (EBP) due to a PEG tube and a wound, as indicated by physician orders. The signage on the resident's door clearly instructed staff to wear gloves and a gown when performing care activities such as transferring the resident. Despite these instructions, both nurse aides only donned gloves and did not wear isolation gowns while transferring the resident to bed. When questioned, both nurse aides demonstrated a lack of understanding regarding the meaning of the signage and the yellow sticker by the resident's name, incorrectly associating it with fall risk rather than infection control precautions. The Nurse Practice Educator confirmed the intended meaning of the signage and the yellow sticker, which was to identify the resident as requiring EBP. The failure to follow the facility's infection control policy and the lack of staff awareness regarding EBP protocols were directly observed during the care of this resident.