Failure to Implement Enhanced Barrier Precautions for Resident With Open Wound
Penalty
Summary
The deficiency involves the facility’s failure to maintain its infection prevention and control program for a resident on enhanced barrier precautions (EBP). The resident was an adult female with type 2 diabetes and chronic kidney disease who was dependent on staff for ADLs, bed mobility, and transfers. Her physician orders included treatment for an open coccyx wound with cleansing, application of calcium alginate, and a dry dressing daily and as needed, but there was no physician order for EBP related to this wound, despite facility practice and staff statements that residents on EBP should have such an order. Surveyors observed that on the morning of the survey, the resident’s room had a PPE supply cart outside the door but no EBP sign posted at the door or doorway entrance, even though the resident had an open coccyx wound and was being treated under EBP practices. Later that same day, two EBP signs were observed posted on the wall outside the resident’s room, indicating that staff and providers must wear gown and gloves for specified high-contact resident care activities, including wound care and other listed tasks. The resident confirmed she had a wound on her buttocks that nurses treated daily with cream and a dressing, and that staff wore gowns and gloves when performing wound care. Multiple staff interviews confirmed that the resident was on EBP and that facility practice required residents on EBP to be identified by a sign outside the room and to have a physician order for EBP. An LVN stated that residents with wounds were on EBP, that everyone was responsible for ensuring EBP signs were posted, and that the resident should have had a sign on her door. The wound treatment nurse stated that residents on EBP, including this resident with a coccyx wound, were identified by door signage and should have a physician order for EBP. The Administrator also stated that residents on EBP had a sign outside their room and a physician order, and that EBP should be reflected in the care plan and Kardex. The facility’s infection prevention and control policy indicated that EBP may be implemented for residents with wounds or indwelling devices and that residents with significant wounds requiring dressings should be under EBP, with gown and glove use during high-contact care activities.
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