A resident with DM, anemia, and adult failure to thrive had signs and symptoms of UTI, and the physician ordered in and out urine collection for UA and C&S along with empiric Bactrim pending results. The LVN could not locate any UA/C&S results in the EHR or paper chart, and the IPN stated he did not know whether the catheterization was completed or follow up on whether the specimen was sent to the lab or the results were received. The DON stated nursing staff and the IPN were supposed to follow up to confirm the UTI diagnosis and guide antibiotic treatment.
A resident with hepatic encephalopathy, liver cirrhosis, and chronic kidney disease had a physician’s order for daily ammonia level testing, but the facility failed to obtain and submit blood specimens on multiple ordered days. The resident and a family member reported that tests were not being done at the facility and that the resident’s most recent ammonia level had only been checked at the hospital. Nursing staff acknowledged that nurses were responsible for drawing and delivering specimens to the hospital lab, documenting the draws, tracking results, and notifying management and the MD if unable to complete the tests. Review of records and confirmation from the outside laboratory showed no ammonia specimens were received from the facility on the missed days, confirming that the ordered daily labs were not carried out.
The facility failed to ensure timely lab draws and results for four residents, including delayed C. diff stool testing after a change in bowel pattern, delayed STAT CBC/BMP/UA with C&S for a resident with UTI symptoms and hematuria, and repeated delays and communication problems around PT/INR monitoring for two residents on warfarin. Nursing staff documented multiple unanswered calls and faxes to the contracted lab, specimens that became non-viable or had to be redrawn, missing or incomplete requisitions, and PT/INR and urine culture results not returned within the facility’s stated expectations for STAT and routine testing. The DON and Administrator acknowledged that the new lab vendor was not meeting expected turnaround times and that there was no alternative lab arrangement in place, contributing to prolonged periods without needed lab information for these residents.
A resident with severe cognitive impairment and multiple medical conditions did not receive physician-ordered lab tests, including CBC, CMP, and magnesium, due to staff failing to process the requisition and notify the physician of the missed tests.
A resident with multiple diagnoses, including cellulitis and cancer, did not receive a physician-ordered CBC with differential after the initial blood sample was unusable. Facility staff did not follow up with the laboratory to ensure the test was completed, resulting in the test not being performed as required by facility policy.
A resident with multiple medical conditions did not have a physician-ordered blood draw completed as scheduled. The lab service log indicated a refusal, but the resident denied refusing, and there was no documentation in the nursing notes to support a refusal. The LVN signed the log but did not document the event, and the DON confirmed that such refusals should be documented and the physician notified.
A resident did not receive stat CBC and CMP laboratory tests as ordered by the physician, with no evidence in the medical record that the tests were completed. Nursing staff and laboratory interviews confirmed that the stat order was not processed or communicated as required, and there was no documentation of follow-up or notification to the physician regarding the delay. The DON and Administrator acknowledged the deficiency.
A resident with anemia and recent gastrointestinal bleeding did not receive ordered STAT laboratory tests before being discharged to a hospital. Although initial labs were drawn, a repeat STAT hemoglobin and hematocrit (H/H) was ordered but not completed, as the lab phlebotomist did not arrive and staff did not document follow-up or completion. The DON confirmed the STAT labs were not done as required, resulting in a failure to provide necessary lab services and a potential delay in care.
A resident with multiple medical conditions and severe cognitive impairment did not receive a physician-ordered comprehensive metabolic panel (CMP) because staff failed to obtain the required blood sample and did not document the omission. Facility staff confirmed the test was not performed and no explanation was recorded, resulting in the absence of necessary laboratory information for the resident's care.
A resident's stat orders for CBC, BMP, and urinalysis with C&S were not completed promptly as required, with delays in sample collection and no documentation that the lab was contacted immediately. Nursing staff confirmed the lack of timely action and follow-up, and the DON acknowledged the deficiency.
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