Failure to Complete Physician-Ordered Laboratory Testing
Penalty
Summary
The facility failed to ensure that professional standards of nursing practice were maintained by not following physician orders for laboratory diagnostic testing for one resident. The resident, a cognitively intact female admitted with a fractured left hip, malnutrition, and COPD, had multiple physician orders for laboratory tests including CBC, CMP, TSH, and FT4 to monitor a new condition of anemia following surgery. These orders were entered on several occasions by both a nurse practitioner and a medical doctor, specifying that the labs were to be completed on certain dates and results reported to the provider. Despite these orders, review of the Medication Administration Record (MAR) and electronic MAR showed no documentation that the required labs were completed as ordered. Interviews with nursing staff, including LPNs, an RN, the Nurse Manager, the DON, and the Regional Nurse Consultant, confirmed that the labs were not drawn on the specified dates and that no results could be located. Staff reported that while labs were typically drawn weekly by a lab nurse, it was the responsibility of facility nurses to draw labs on other days if ordered. The failure to complete the ordered laboratory testing resulted in the facility not meeting professional standards of quality for nursing services.