Failure to Ensure Resident Identification Led to Blood Draw Error
Penalty
No penalty information released
The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.
Summary
A deficiency occurred when a resident did not have an identification wrist band, which resulted in the wrong individual having their blood drawn. The incident was discovered after a complainant noticed gauze and tape on the resident's hand during a visit and learned from the roommate that a lab technician had mistakenly drawn the resident's blood. Facility staff were initially unaware of the incident until a grievance was filed. A review of facility grievances and subsequent investigation confirmed that the resident did not have an armband at the time of the error, directly leading to the mistaken blood draw.