F0635

D

Failure to Obtain Physician Order for Enhanced Barrier Precautions at Admission

Weslaco, Texas Survey Completed on 03-03-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in that the facility failed to obtain physician orders for a resident’s immediate care related to Enhanced Barrier Precautions (EBP) at the time of admission. The resident was an older male admitted with multiple significant diagnoses, including cerebral infarction, metabolic encephalopathy, dysphagia, cognitive communication deficit, muscle wasting and atrophy, and gastrostomy status with a feeding tube in place. The resident’s MDS showed severe cognitive impairment with a BIMS score of 4 and documented use of a feeding tube on admission. The baseline care plan indicated the resident required tube feeding and was dependent on staff for tube feeding and water flushes, and the order summary reflected an active enteral feeding order starting on the admission date.

Record review showed that from admission through several days afterward, there were no physician orders for EBP, despite the resident having a feeding tube, which the facility’s policy defined as an indwelling medical device requiring an EBP order. The DON stated that the resident required EBP since admission due to the feeding tube and acknowledged that no EBP order was in place, although staff were aware of and followed EBP. The ADON confirmed that residents with feeding tubes required EBP because the tube was an invasive device and that the team was supposed to review physician orders for accuracy. The Administrator also stated that residents with feeding tubes needed EBP orders and that the team reviewed new admission orders to ensure they were in place. The facility’s EBP policy specified that an order for EBP would be obtained for residents with wounds or indwelling medical devices, including feeding tubes, even if they were not known to be infected or colonized with MDROs.