Failure to Conduct Admission Lab Tests
Summary
The facility failed to provide or obtain necessary laboratory services for a resident upon admission, as per the physician's standing orders. The resident, a cognitively intact female with a history of acute kidney failure, muscle weakness, and muscle wasting, was admitted to the facility but did not have the required laboratory tests, including BMP, CBC, U/A, and lipid profile, conducted at the time of admission. The lab work was delayed and only completed several days later, despite the resident experiencing symptoms such as burning during urination and discomfort, which were reported to the FNP. Interviews with facility staff, including the DON, ADM, RN, and LVN, revealed a lack of clarity and communication regarding the responsibility for initiating and documenting admission lab orders. The facility's policy required licensed nurses to obtain and transcribe orders according to practice guidelines, but this was not followed. The FNP was unaware that the admission labs had not been completed, indicating a breakdown in communication and adherence to the facility's standard procedures.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident with multiple chronic conditions did not receive several physician-ordered lab tests, including prealbumin, hemoglobin A1C, and basic metabolic panels. These tests were not found in the lab portal or medical record, and the DON confirmed their absence. The nurse practitioner stated some orders were placed by accident, and the facility's policy requiring completion of ordered diagnostic tests was not followed.
The facility did not have a contract with a laboratory service to provide blood bank services, relying instead on a hospital's services. The administrator was unsure if the facility could provide transfusion services if needed, as the current policy was hospital-based.
Failure to Obtain Ordered Laboratory Tests for a Resident
Penalty
Summary
The facility failed to follow physician orders by not obtaining ordered laboratory tests for a resident with multiple diagnoses, including diabetes mellitus type 2, chronic kidney disease, COPD, and Parkinson's disease. Record review showed that several laboratory tests, such as prealbumin, hemoglobin A1C, and basic metabolic panels, were ordered by the physician on multiple occasions but were not found in the laboratory portal or the resident's medical record. These tests were intended to monitor the resident's nutritional status, blood sugar control, and kidney function, but there was no documentation that they were completed as ordered. Interviews with the Director of Nursing (DON) confirmed that the laboratory tests could not be located in the records or portal. The DON also reported that the nurse practitioner who placed the orders indicated some were made by accident. The facility had recently changed management, and the DON was unable to clarify why the lab orders were not completed at the time they were ordered. The facility's policy requires that physicians identify and order diagnostic and lab testing based on residents' needs, but this was not followed in this case.
Lack of Contractual Relationship with Blood Bank Services
Penalty
Summary
The facility failed to establish a contractual relationship with a blood bank service to provide necessary transfusion services on-site. During an interview, the facility administrator admitted that there was no existing contract with a laboratory service to facilitate blood bank services, despite the facility's hospital-based status. Instead, the facility relied on the Episcopal San [NAME] Metro Hospital's laboratory services, which are Joint Commission accredited and Medicare certified. However, there was uncertainty about whether the skilled nursing facility would be able to provide transfusion services if needed, as the current transfusion policy and procedure were hospital-based and directed towards the Episcopal Hospital San [NAME] Metro.
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