Delayed Execution of Physician Orders for UTI Management
Penalty
Summary
The facility failed to ensure that physician orders were carried out in a timely manner for a resident with a history of multiple complex medical conditions, including dementia, diabetes, morbid obesity, chronic obstructive pulmonary disease, rheumatoid arthritis, urinary tract infection, hypertension, breast cancer, depression, and chronic kidney disease. The resident required significant assistance with activities of daily living and was at risk for pressure sores. Physician orders included transporting the resident to a nephrology appointment and obtaining urinalysis (UA) and culture and sensitivity testing for urinary tract infections on specific dates. There were documented delays in both transporting the resident to the nephrology appointment and in collecting urine samples for ordered testing. The resident was not transported to the nephrology appointment due to scheduling confusion, and urine samples for UA and culture were not collected promptly after orders were given. For example, a urine sample ordered on one date was not collected until several days later, and similar delays occurred with subsequent orders. The Director of Nursing acknowledged these delays and indicated that collecting urine from the resident was difficult, but also stated that the samples should have been collected as ordered. Additionally, there were delays in receiving culture and sensitivity results from the laboratory, with results taking longer than the facility's policy expectations. The Nurse Practitioner was not notified of the delays in obtaining urine samples, and alternative collection methods, such as straight catheterization, were not considered because the delays were not communicated. Facility policies regarding transportation and physician orders were provided, but a specific policy for following physician orders for urinalysis testing was not available upon request.