Failure to Notify Physician and Follow Up on Elevated Keppra Level
Penalty
Summary
The facility failed to promptly notify and follow up with the ordering physician regarding a laboratory result that was outside the clinical reference range for one resident. The resident, an elderly female with a history of cerebrovascular disease, seizures, and dementia, had a physician's order for a Keppra level to be drawn and monitored. The lab result, received and electronically signed by the medical director, showed a Keppra level above the therapeutic range. The medical director specifically questioned the resident's current Keppra dosage in response to the elevated result. Despite the physician's inquiry, there was no documented response from the nursing staff regarding the resident's current Keppra dose. Review of the facility's 24-hour reports and progress notes revealed no indication that the lab result was addressed or that the physician's question was answered. The resident continued to receive her prescribed Keppra dosage, and there was no documentation of any changes to her medication or further follow-up regarding the elevated lab value. Interviews with the DON and nursing staff confirmed that the elevated Keppra level and the physician's inquiry were not followed up on or documented. The DON acknowledged that the lab result was not written on the 24-hour report for follow-up and that the process for addressing such results was not completed. The facility's policy required prompt physician notification and withholding of the next dose in the event of a high or toxic medication level, but this procedure was not followed in this instance.