F0880

D

Failure to Follow Hand Hygiene and Medication Handling Practices During Med Pass

Pasco, Washington Survey Completed on 03-19-2026

Penalty

No penalty information released

Summary

The facility failed to implement its infection prevention and control program during a medication pass by a registered nurse, identified as Staff G. The facility’s policy required an infection prevention and control program with standard precautions, including hand hygiene before and after resident contact, before unsterile tasks, and after contact with objects in resident rooms. During observation, Staff G was noted at the medication cart with fingernails extending beyond the fingertips and dark brown matter under the nails. Staff G obtained a card of narcotic medication, popped a pill out of the card into their bare hand, and then placed the pill into a medication cup, contrary to facility expectations that staff not touch medications with bare hands.

Resident 1, who had diagnoses including respiratory failure, kidney failure, and anemia and was independent in ADLs with intact cognition, reported that Staff G did not handle medications properly. The resident stated that Staff G did not wear gloves, did not wash hands before or after passing medications, and repeatedly popped medications into a bare hand before placing them into a medication cup, and that these poor infection control practices had been observed on more than one occasion. In a separate observation, Staff G handed a medication cup and water to a resident, received the used cups back, exited the room, and immediately prepared another resident’s medication by popping it from a card into a medication cup without performing hand hygiene after leaving the room or before preparing the next dose. In interviews, the DON and the Administrator confirmed that staff were expected to perform hand hygiene between residents and to avoid touching medications with bare hands, and acknowledged that the infection control process during medication pass was not followed.