Failure to Implement Enhanced Barrier Precautions and Equipment Disinfection
Penalty
Summary
The facility failed to implement proper Enhanced Barrier Precautions (EBP) for a resident undergoing dialysis. During observation, it was found that the resident's room did not have the required EBP signage or an isolation cart set up outside the door, despite the resident having an indwelling medical device (AV fistula) for hemodialysis. Interviews with nursing staff confirmed that the resident should have been on EBP due to the dialysis access, but the necessary precautions were not in place at the time of the survey. Additionally, there was no written physician order for EBP in the resident's chart, nor was there an EBP care plan documented prior to the surveyor's inquiry. The facility's policy, revised in March 2023, specifies that residents with indwelling medical devices, such as hemodialysis catheters, must be placed on EBP. This includes posting clear signage outside the resident's room, making PPE (gowns and gloves) available immediately outside the room, and ensuring access to hand hygiene products. The policy also requires a written physician order and a care plan for residents on EBP. These requirements were not met for the resident on dialysis at the time of the survey. In a separate observation, a LPN was seen using reusable vital sign equipment on a resident and then attempting to use the same equipment on another resident without cleaning or disinfecting it. The facility's policy requires that all non-critical resident-care items, such as blood pressure cuffs and pulse oximeters, be cleaned and disinfected between uses on different residents. The LPN acknowledged that cleaning and disinfection should occur after each use, and the DON confirmed this requirement during interview.