Failure to Follow Enhanced Barrier Precautions for Resident With NG Feeding Tube
Penalty
Summary
The deficiency involves the facility’s failure to maintain an infection prevention and control program, specifically related to Enhanced Barrier Precautions (EBP) and safe handling of a nasogastric (NG) feeding tube for one resident. The resident was admitted with cerebral palsy, unspecified dysphagia, unspecified severe protein-calorie malnutrition, and cachexia, and had an NG feeding tube with continuous tube feeding. Surveyors observed that the resident’s room had an EBP sign on the door, but on one occasion the tube feeding pump was beeping with an inactive status and one end of the feeding tube was uncapped and touching a metal IV pole. A registered nurse entered the room, donned only gloves, picked up the uncapped end of the feeding tube from the IV pole, and reattached it to the NG tube without wearing a gown, despite the resident being on EBP. On another occasion, a speech therapist entered the same resident’s room, donned gloves but did not wear a gown, and conducted a feeding session. The therapist knelt on the floor and administered multiple trials of different fluids and foods, adjusted the resident in bed, and then exited the room without donning a gown at any time. Speech therapy documentation confirmed that the resident received multiple oral trials of yogurt, apple juice, and a peach, with noted anterior loss of bolus and difficulty determining safety due to the resident’s inability to hold the bolus in the oral cavity. In interviews, the RN, CNA Coordinator, and DON all stated that residents with feeding tubes or other indwelling devices required PPE including gowns and gloves, and that EBP should be followed for residents with feeding tubes, with gowns required when handling tube feedings or feeding the resident. These observations and statements show that staff did not follow the facility’s EBP requirements for this resident.
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