Failure to Complete Ordered Diagnostic Evaluation for Suspected Scabies
Penalty
Summary
The facility failed to follow physician-ordered diagnostic evaluation for suspected scabies in one resident, which contributed to a delay in identifying and mitigating the spread of scabies among residents. Specifically, a resident with dementia and major depressive disorder developed a raised papular rash, and the CRNP ordered a dermatology consultation, skin scraping, or biopsy to determine the cause. Although these diagnostic procedures were ordered, there was no documentation that they were completed, and the resident was instead treated for an allergic-type rash and later with various topical and oral medications for skin symptoms. Over the following weeks, the resident's symptoms persisted and worsened, with continued itching, scratching, and the development of additional lesions. Despite ongoing symptoms and further physician orders for different treatments, the facility did not obtain the required dermatology evaluation, skin scraping, or biopsy as initially ordered. Eventually, a wound physician identified the rash as consistent with a mite reaction on microscopic examination, and the resident was treated for scabies with permethrin cream and placed on contact precautions. The failure to promptly complete the ordered diagnostic evaluation potentially contributed to the spread of scabies within the facility. Another resident was confirmed positive for scabies on microscopic exam, and a total of thirty-six residents received treatment for exposure. Interviews with the Infection Preventionist and DON confirmed that the lack of timely diagnostic follow-through may have delayed identification and mitigation of the outbreak.