Delay in Antibiotic Administration for UTI Due to Lapses in Communication and Protocol
Penalty
Summary
A resident with a history of renal dialysis, urinary tract infection (UTI), and diabetes mellitus experienced a significant delay in receiving prescribed antibiotic treatment for a UTI. The resident first reported symptoms of dysuria and voiding hesitancy, prompting a physician's order for a urinalysis with culture and sensitivity. The urine sample was collected two days after the order, and laboratory results indicating infection were available three days later. However, there was no documented evidence that the abnormal urinalysis results were communicated to the physician or that a change of condition was initiated at that time. The facility received the culture and sensitivity results and obtained a physician's order for Ertapenem, an intramuscular antibiotic, to be administered daily for seven days. Despite this, the first dose of the antibiotic was not given until four days after the order was received. Documentation showed that the delay was due to concerns about a penicillin allergy and confusion regarding the route of administration, but there was no evidence that the physician was notified of these issues or the delay in starting the medication. Interviews with facility staff, including the Registered Nurse Supervisor, Medical Doctor, and Director of Nursing, confirmed that the facility's processes for timely collection of samples, prompt notification of abnormal lab results, and immediate initiation of ordered antibiotics were not followed. The facility's policies required prompt action in response to changes in condition and abnormal laboratory findings, but these procedures were not adhered to, resulting in a nine-day delay from the onset of symptoms to the administration of the prescribed antibiotic.