Failure to Implement Enhanced Barrier Precautions for Resident with Indwelling Urinary Catheter
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions (EBP) for a resident with an indwelling urinary catheter, as required by their infection prevention and control program. The resident's physician order sheet documented the need for EBP due to the presence of a urinary drainage catheter. During observation, the resident was found in bed with a urinary drainage bag, but there was no EBP sign on the door, and no isolation cart was present outside the room. Staff interviews revealed that the hospice certified nursing assistant providing personal care to the resident only wore gloves and a mask, and was unaware of the facility's EBP requirements. The assistant director of nursing confirmed that residents with indwelling urinary catheters should be on EBP, with appropriate signage and equipment in place, which was not observed for this resident. The facility's policy, revised on 12/10/24, specifies that EBP should be used in conjunction with standard precautions, including donning gowns and gloves during high-contact care activities for residents with indwelling medical devices. The policy also outlines the specific care activities and situations where EBP is indicated. Despite these requirements, the staff did not follow the policy for the resident with a urinary catheter, as evidenced by the lack of signage, equipment, and proper use of personal protective equipment during care.