Failure to Complete Physician-Ordered Laboratory Tests
Penalty
Summary
The facility failed to provide timely and complete laboratory services as ordered for two residents. For one resident with diagnoses including malnutrition, schizophrenia, and bipolar disorder, the physician ordered a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), and Ammonia level. Review of the resident's records and interview with a Licensed Vocational Nurse revealed that these lab tests were not completed, and there were no results available. The nurse confirmed that the labs were ordered to monitor the resident due to her medications, but the required tests were not performed. For another resident with encephalopathy, generalized edema, and dependent on staff for all functional abilities, there was a physician's order for weekly pre-albumin blood draws to monitor protein levels. Record review and interview with a Registered Nurse showed that the weekly pre-albumin labs were not performed as ordered, with only sporadic draws documented over several months. The facility's policy stated that clinical laboratory services are to be provided to meet residents' needs, but these orders were not consistently carried out.