Failure to Timely Obtain Urinalysis and Notify Physician
Penalty
Summary
The facility failed to provide needed services in accordance with professional standards by not obtaining a urinalysis (UA) in a timely manner and failing to notify the physician of the failed attempt for one resident. The resident, who had moderate cognitive impairment and chronic kidney disease, had a physician's order for a one-time UA with culture and sensitivity, which was to be completed within a specified timeframe. However, the UA was not obtained until six days after the order was placed, despite multiple staff being aware of the outstanding order and the resident's ongoing need for the test. Documentation and interviews revealed that staff were unclear about the procedures for timely notification of the physician when unable to obtain a UA. The nurse responsible stated she would wait up to 48 hours before notifying the physician or requesting a straight catheterization, but in this case, the delay extended to five days. Communication among staff was inconsistent, with some staff unaware of the order and others not taking steps to facilitate urine collection, such as placing a collection hat in the bathroom. The resident's family also questioned why the physician was not notified sooner about the inability to obtain the UA. The delay in obtaining the UA was further compounded by confusion regarding specimen collection and communication breakdowns between shifts. The order for the UA was acknowledged by staff, but there was no clear policy or procedure guiding how quickly the lab should be obtained or when to escalate to the physician. The Director of Nursing confirmed that the expectation was for the UA to be obtained before the six-day delay occurred, but acknowledged the absence of a formal policy on the matter.