Failure to Obtain Physician Orders for Vancomycin Trough Monitoring
Penalty
Summary
A deficiency occurred when the facility failed to ensure that physician orders were in place to monitor vancomycin levels for a resident receiving intravenous (IV) vancomycin therapy. The resident, admitted with diagnoses including orthopedic aftercare, streptococcal arthritis, and osteomyelitis, was discharged from the hospital with orders for IV vancomycin every 24 hours for 28 days and a weekly vancomycin trough level to monitor medication levels. The hospital had drawn a vancomycin trough prior to discharge, and the resident was admitted to the facility for continued IV antibiotic therapy and rehabilitation. Upon review of the resident's medical record, it was found that while orders were in place for a complete blood count (CBC), basic metabolic panel (BMP), and regular assessment of the PICC line site, there were no physician orders for the required vancomycin trough level monitoring. This omission was confirmed during an interview with the Director of Nursing, who verified that no order for a vancomycin trough was present during the resident's stay. The lack of appropriate monitoring orders for vancomycin levels constituted the deficiency identified in the report.