Failure to Implement Enhanced Barrier Precautions and Proper Infection Control During Medication Administration
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control policies, including enhanced barrier precautions (EBP), for residents with qualifying conditions and to maintain appropriate infection control during medication administration. Facility policy on EBP, revised December 2024, states that EBP apply when a resident is not known to be infected or colonized with an MDRO, has a wound or indwelling medical device, and does not have secretions or excretions that cannot be contained. Resident 11 had diagnoses including an artificial opening of the urinary tract and an open abdominal wall wound, with a nephrostomy and a urostomy in place, but there was no EBP signage on the room door, no physician order for EBP, and no care plan addressing EBP. Resident 35 had an unstageable pressure ulcer and venous ulcers, including an unstageable pressure ulcer on the right plantar foot with moderate serosanguinous drainage, yet there was no EBP signage on the room door, no physician order for EBP, and no care plan addressing EBP. In interviews, the DON stated that both residents should have been on EBP and that facility policy should have been followed. Additional infection control deficiencies were identified during medication administration observations. On two separate medication carts, spoons used for medication administration were stored completely exposed—on one cart in a plastic bin on top of the cart and on another in a box on the side of the cart. During a medication pass, an LPN (Employee 4) did not perform hand hygiene between administering medications to two residents. The LPN donned gloves before entering a resident’s room to administer eye drops and clean the resident’s eyes, then touched the trash can lid and medication cart handles with the gloved hands, adjusted the resident’s bed using the bed control panel, and administered oral medications without changing gloves. The LPN then opened the resident’s bathroom door, wetted a washcloth, cleansed and dried the resident’s eyes, and administered eye drops while still wearing the same gloves, exited the room carrying the used washcloth, removed gloves at the cart, and carried the washcloth down the hall to the soiled utility room before performing hand hygiene. The DON confirmed the expectation that nursing staff follow appropriate infection control guidelines during medication administration.
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