Failure to Follow Enhanced Barrier Precautions and Oxygen Tubing Change Protocols
Penalty
Summary
The deficiency involves the facility’s failure to maintain an effective infection prevention and control program, specifically related to enhanced barrier precautions (EBP) and respiratory equipment care. For one resident with wounds, federal guidance on EBP indicated that residents with wounds require targeted gown and glove use during high-contact care activities such as wound care and assisting with positioning. The resident had active wound care orders for a right shin wound and a stage 2 pressure ulcer. During an observed wound care procedure, there was a sign on the resident’s door directing staff to use EBP for high-contact care, and PPE was available in a bin next to the door. Despite this, the wound care nurse did not don a gown while performing wound care, and the CNA assisting with positioning also did not wear a gown. The CNA was observed rolling the resident onto her side so that the front of the resident’s body was against the CNA’s body. Both staff later confirmed they had not worn gowns, and the DON confirmed that all staff are expected to follow EBP for high-contact care, including wound care and assistance with wound care. A second deficiency involved failure to follow physician orders for changing and labeling oxygen tubing for a resident with COPD who was receiving oxygen at 2 LPM via nasal cannula. The physician’s orders required weekly oxygen tubing changes and labeling each component with the date and initials. During observation and interview, the resident was wearing a nasal cannula that had no date indicating when it was last changed, and the resident did not know when or how often staff changed it. The CNA confirmed that the nasal cannula lacked a date and that she could not determine when it was last changed, stating that staff are expected to write the date on the tubing when it is changed. The DON later confirmed that staff are expected to change oxygen tubing every seven days and label it with the date of change, which had not been done for this resident.
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