Failure to Timely Complete and Communicate Physician-Ordered Lab Test
Penalty
Summary
The facility failed to ensure that physician-ordered laboratory testing was completed in a timely manner for a resident with multiple complex medical conditions, including anoxic brain damage, type II diabetes mellitus with chronic kidney disease, dependence on renal dialysis, anemia, malnutrition, and a gastrostomy. The resident was admitted and later discharged during the review period, and required total assistance for toileting, with interventions in place to monitor and report bowel movements. On a specific date, a nurse practitioner ordered a Hemoccult test to be performed with the next bowel movement and for the physician to be notified upon completion, with the order to be carried out every shift until discontinued. Review of the resident's medical record and medication administration records revealed inconsistent documentation regarding the collection and completion of the Hemoccult test. Over the course of several days, nursing notes frequently indicated either no bowel movement or failed to specify whether a sample was obtained. There were multiple shifts where no response was recorded, and the majority of entries either marked the test as not applicable or provided no clear indication of test completion. The only documented result was a negative Hemoccult test recorded more than two weeks after the initial order, with no evidence that the physician was notified of the result in a timely manner. Interviews with nursing staff and the nurse practitioner confirmed that there was no evidence of a Hemoccult test being obtained or resulted until well after the order was placed, and that the result was not timely according to the expectations for such testing. The nurse practitioner specifically stated that a timely result would be within 24 hours of obtaining a sample, and acknowledged that the result obtained was not within this timeframe. This failure to complete and communicate the ordered laboratory test in a timely manner constituted a deficiency in meeting the needs of the resident and potentially affected all residents in the facility.