Failure to Follow Enhanced Barrier Precautions During Resident Care
Penalty
Summary
A deficiency occurred when staff failed to follow Enhanced Barrier Precautions (EBP) for a resident with a stage 4 pressure ulcer. The resident, who had diagnoses including hepatic encephalopathy, COPD, and dementia, was totally dependent on staff for activities of daily living (ADLs) such as eating, oral hygiene, and toileting. The resident's medical records indicated severely impaired cognitive skills and an inability to make medical decisions. During an observation, a Certified Nurse Assistant (CNA) was seen providing ADL care to the resident without wearing a gown, despite the resident being on EBP due to the presence of an open wound. Interviews with the CNA, Director of Staff Development (DSD), and Director of Nursing (DON) confirmed that EBP protocols require staff to wear gloves, mask, and gown when providing care to residents with wounds or medical devices to prevent the spread of multi-drug-resistant organisms (MDROs). The CNA acknowledged forgetting to use a gown during care. Review of the facility's policy confirmed that gown and glove use is required for high-contact care activities under EBP, such as dressing, bathing, and toileting.