Failure to Follow Enhanced Barrier Precautions During G-Tube Medication Administration
Penalty
Summary
A deficiency occurred when a Licensed Practical Nurse (LPN) failed to follow the facility's Enhanced Barrier Precautions (EBP) protocol during medication administration for a resident with a gastrostomy tube (G-Tube) who was on EBP due to the presence of an indwelling medical device and risk for multi-drug resistant organisms (MDROs). The resident was documented as severely cognitively impaired and dependent on staff for all activities of daily living, including oral hygiene, toileting, bathing, dressing, personal hygiene, bed mobility, and transfers. The resident's care plan and physician orders required staff to use gown and gloves during high-contact care activities, such as G-Tube care, to prevent the transmission of MDROs. On the observed date, the LPN administered water flushes, medications, and nutritional bolus feeding through the resident's G-Tube without wearing a gown, despite signage and available personal protective equipment (PPE) outside the resident's room indicating EBP requirements. The LPN acknowledged awareness of the EBP protocol and the need to wear a gown during these activities. Additionally, the Director of Nursing (DON) confirmed that the LPN should have checked the placement of the G-Tube prior to administering any substances, as failure to do so could result in improper administration. The facility's policy, reviewed prior to the incident, clearly outlined the necessity of gown and glove use during high-contact care for residents on EBP.