Delay in Urine Specimen Collection and Physician Notification
Penalty
Summary
A deficiency occurred when staff failed to collect a urine specimen for a resident who was symptomatic for a urinary tract infection, as ordered by the physician. The resident, who had chronic kidney disease, congestive heart failure, diabetes mellitus, a colostomy, and was incontinent of bladder, exhibited symptoms such as lethargy, confusion, and dysuria. Despite a physician's order to obtain a urine specimen and, if necessary, to straight catheterize the resident, there was no documentation of attempts to collect the specimen or notification to the physician regarding the delay over several days. The resident's care plan included interventions for toileting, incontinent care, and obtaining lab work as ordered, but these were not followed in a timely manner. Nursing notes and interviews confirmed that the urine specimen was not collected until four days after the initial order, and the physician was not notified of the delay. The facility's infection control nurse stated that the expectation was to collect a urine sample within twenty-four hours of the order and to notify the physician if there was a delay. The delay in obtaining the specimen resulted in a delay in diagnosis and treatment of the resident's urinary tract infection. Facility documentation and interviews indicated that the failure to follow protocol led to the deficiency.