Failure to Include and Implement Enhanced Barrier Precautions in Resident Care Planning
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement care plans that included Enhanced Barrier Precautions (EBPs) for residents requiring such precautions, and failure of staff to use required personal protective equipment (PPE) during high-contact care. Surveyors observed an EBP sign on the door of a resident’s room and a PPE cart outside the door, indicating that EBPs were required. During wound care to the resident’s coccyx, a nursing assistant (NA), who was an agency aide, assisted a registered nurse (RN), also an agency nurse, while wearing only gloves and a mask. The RN entered the room wearing a mask, gloves, and a gown but did not instruct the NA to don a gown, even though the NA was performing high-contact care by turning and holding the resident in position. The resident did not participate in bed mobility and was dependent on staff for all care and mobility. The resident’s admission MDS documented diagnoses of Alzheimer’s disease and a stage IV pressure ulcer, with severely impaired cognition and total dependence on staff. The resident’s care plan directed assistance of one to two staff for all care but did not include directions for EBPs during high-contact care. The NA reported receiving only verbal instructions about resident care upon starting work and stated she had not been shown how to access residents’ care plans or the Kardex. She did not see the EBP sign on the door and did not know the PPE cart was intended for that resident, although she was aware of EBP practices in general. The ADON/infection control nurse acknowledged that EBPs, including gown and gloves, should be used for identified residents during high-contact care, that NAs are to reference the Kardex for required precautions, and that EBPs had been missed in the resident’s care plan. Facility policies on EBPs and comprehensive person-centered care plans required incorporation of identified problems, risk factors, and current standards of practice, including targeted gown and glove use for MDRO control, which were not reflected in this resident’s care plan or consistently implemented by staff.
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