Failure to Obtain Timely Urology Consultation for Resident with Recurrent UTIs
Penalty
Summary
The facility failed to obtain a timely urology consultation for a resident with significant medical conditions, including quadriplegia, paraplegia, neuromuscular dysfunction of the bladder, and an indwelling Foley catheter. The resident experienced multiple urinary tract infections (UTIs), including infections with Extended Spectrum Beta-Lactamase (ESBL) producing bacteria and Proteus Mirabilis, and was treated with antibiotics on more than one occasion. Despite physician and nurse practitioner documentation indicating the need for a urology consult, there was no evidence in the progress notes that a urologist consultation was requested or completed. Interviews with the resident and staff confirmed that the resident had not seen a urologist and was not informed of any scheduled appointment. The resident expressed awareness that a consult had been ordered but was unaware of any follow-up or arrangements for transportation, which he required due to his physical limitations. Staff interviews revealed uncertainty about whether a consult had been requested, and the Assistant Director of Nursing was unable to provide documentation of a urology consult by the end of the survey.