Failure to Implement Enhanced Barrier Precautions per Physician Orders
Penalty
Summary
The deficiency involves the facility’s failure to implement physician-ordered enhanced barrier precautions (EBPs) for a resident with multiple high-risk conditions. The resident, admitted with paraplegia, hypertension, neuromuscular bladder dysfunction, and stage four pressure ulcers on both hips, had an indwelling urinary catheter, an ostomy, and two stage four pressure ulcers present on admission. The quarterly MDS showed the resident had intact cognition. Physician orders dated 08/05/25 required staff to use gowns and gloves for high-contact resident care activities, including dressing, bathing/showering, transfers, hygiene, toileting, changing linens, changing briefs, dressing changes, and care of any device such as wounds, catheters, or ostomies. The resident’s care plan also specified the need for EBPs related to wounds, colostomy, and indwelling urinary catheter, with interventions directing staff to wear EBP PPE during high-contact care. During observation, the resident was in bed with a sign posted on the door indicating EBPs and instructing staff to wear a gown and gloves during care, and a PPE bin with gowns was available outside the room. A CNA was observed providing care while wearing gloves but no gown. The CNA performed multiple high-contact activities, including oral care, placing a pillowcase on a pillow, repositioning the resident in bed, and emptying the urinary catheter drainage bag, all without donning a gown. In interview, the CNA confirmed these care activities, stated she was unaware the resident was on EBPs, reported she had not noticed the sign, and indicated that staff were not in the habit of wearing gowns and that she had not received training on EBPs. The DON confirmed that staff should be wearing PPE for residents on EBPs during high-contact care. Review of the facility’s Enhanced Barrier Precautions policy, revised 12/2024, showed that EBPs require gown and glove use for high-contact care for residents with wounds or indwelling devices and that staff were to be trained prior to caring for residents on EBPs, with signage used to communicate required PPE.
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