Failure to Complete Physician-Ordered CBC with Differential
Penalty
Summary
The facility failed to obtain a complete blood count with differential (CBC with differential) as ordered by the physician for a resident admitted with diagnoses including cellulitis of the lower extremity, malignant neoplasm of the colon, and heart failure. The resident was receiving antibiotic therapy for cellulitis, and the care plan included administering medications as ordered. A physician's order was placed for a repeat CBC with differential, but the initial blood sample collected was clotted and unusable. Although the physician was notified and a new order for blood collection was placed, the laboratory did not collect the sample over the weekend, and there was no documentation that the facility followed up with the laboratory after the weekend to ensure the test was completed. Interviews with facility staff confirmed that the repeat CBC with differential was not completed for the resident. The Infection Preventionist acknowledged that there was no record of follow-up with the laboratory after the initial failed collection, and the Director of Nursing stated that staff should have ensured the test was completed regardless of laboratory notification. Review of facility policies indicated that laboratory services ordered by physicians should be completed in a timely manner to meet residents' needs, but this was not followed in this instance.