Failure to Obtain Provider-Ordered Laboratory Tests for Multiple Residents
Penalty
Summary
Facility staff failed to obtain provider-ordered laboratory tests for four residents, resulting in missing or incomplete lab results as required by medical orders. For one resident with chronic atrial fibrillation and on anticoagulant therapy, PT/INR tests were not obtained on three separate occasions despite clear orders for weekly monitoring. The resident's care plan included interventions for labs as ordered, but the clinical record lacked the required PT/INR results, and the facility was unable to provide them upon surveyor request. Another resident with a left lower buttock abscess and multiple comorbidities had a wound culture ordered by the wound provider, but the initial culture was not obtained as required. The lab later rejected two wound cultures for unclear reasons, and a repeat culture was only obtained during a subsequent provider visit, which revealed significant bacterial growth. The facility could not provide results or documentation for the initial culture order during the survey period. Additional deficiencies included failure to obtain daily INR tests for a resident with a prosthetic heart valve and altered cardiovascular status, as only three out of five ordered tests were completed. Nursing notes confirmed that the tests were not obtained on two of the required days. Another resident with chronic kidney disease and other conditions had a basic metabolic panel ordered, but the results were not found in the clinical record. The order was later discontinued after consultation with a nurse practitioner, but the initial test was not completed as ordered. In all cases, the facility's policy required timely provision or procurement of laboratory services as ordered by providers, which was not met.