Failure to Implement Enhanced Barrier Precautions During High-Contact Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure CNAs implemented Enhanced Barrier Precautions (EBP) as required when providing activities of daily living (ADL) care to two residents on EBP. For Resident 2, surveyors observed an isolation cart and an EBP sign posted at the room entrance, but CNA 1 entered the room without donning an isolation gown and proceeded to assist the resident with ADL care. Resident 2’s records showed diagnoses of chronic respiratory failure, COPD, and ventilator dependence, with documentation that the resident lacked decision-making capacity and had severe cognitive impairment. The MDS indicated the resident was dependent on staff for ADLs, and the care plan for altered bladder elimination due to incontinence directed staff to implement EBP. For Resident 3, surveyors observed an isolation cart and an EBP sign at the room entrance, yet CNA 2 was in the room providing ADL care without wearing an isolation gown. Resident 3’s records documented chronic respiratory failure, Parkinson disease, and ventilator dependence, with an H&P indicating the resident lacked capacity to understand and make decisions and an MDS showing severe cognitive impairment and dependence for ADLs. Physician orders specified EBP related to the resident’s gastrostomy tube and tracheostomy, including applying EBP to prevent spread of infection during specific care activities such as toileting and changing incontinent briefs, and the care plan for bowel and bladder incontinence also directed implementation of EBP. During interviews, CNA 1 and CNA 2 each acknowledged that the posted EBP sign meant a gown should be worn for infection control, and an LVN confirmed that EBP includes donning gown and gloves before high-contact resident care. The facility’s EBP policy required staff to don gowns and gloves before performing high-contact resident activities such as bathing, providing hygiene, changing briefs, or assisting with toileting.
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