Failure to Revise Care Plan for Enhanced Barrier Precautions
Penalty
Summary
Surveyors found that the facility failed to ensure a comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for one resident. The resident was an adult male with diagnoses including sepsis, perforation of intestine, colostomy status, and malignant neoplasm of the rectum. His MDS assessment showed an intact BIMS score of 13 and documented septicemia, sepsis, and a colostomy. The comprehensive care plan, revised on 01/07/2026, addressed his ostomy and risks for complications such as stoma irritation and bleeding, with interventions including colostomy care each shift and monitoring for signs of infection around the stoma. However, the care plan did not include any problem, goal, or interventions related to the resident being on enhanced barrier precautions. During interviews, the DON stated that Resident #2's care plan should have been revised on 01/07/2026 and that either the ADON or DON was responsible for updating care plans at that time, as the newly hired MDS nurse had not yet started working. The DON explained that if a resident had an order for enhanced barrier precautions, the nurse reviewing the physician order could have added it to the care plan, and that all information about a resident, including enhanced barrier precautions, was to be care planned. The Administrator stated she expected any change of condition or treatment, including new orders for enhanced barrier precautions, to be immediately added to the care plan by the nurse, DON, or interim nurse completing care plans, and confirmed that the DON was ultimately responsible for ensuring care plans were completed and revised. Review of the facility’s comprehensive care plan policy, dated December 2015, showed that the IDT must review and update the care plan with significant changes in condition, unmet outcomes, readmissions from hospital, and at least quarterly, but this process was not followed for the resident’s enhanced barrier precautions.
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