Failure to Implement DPH-Recommended Diagnostic Testing During GI Outbreak
Penalty
Summary
The deficiency involves the facility’s failure to follow Department of Public Health (DPH) recommendations for diagnostic testing during a gastrointestinal (GI) outbreak affecting all six units. The facility’s infection surveillance policy states that the Infection Preventionist and the attending physician will determine if laboratory tests are indicated. A GI outbreak with symptoms of nausea, vomiting, diarrhea, and some fevers occurred among 33 residents and 13 staff, and DPH was contacted for guidance regarding a possible Norovirus outbreak. DPH later recommended that individuals experiencing diarrhea receive testing and inquired whether the facility had a contract with a commercial lab. However, the physician was not informed of this recommendation and therefore did not order stool samples, stating he routinely does not order stool cultures and was unaware of DPH’s guidance. The NP reported she was aware of the recommendation to test for Norovirus but declined testing for residents under her care, stating the treatment plan would be the same and that residents were already receiving treatment. Interviews revealed multiple communication and implementation failures related to the DPH recommendations. The Infection Preventionist/Quality Assurance LPN confirmed the scope of the outbreak, but the DON stated she was not aware that the Infection Preventionist had listed a diagnosis for DPH instead of only symptoms and confirmed that the physician should have been informed of the DPH recommendation. The physician standing order required that any treatment or testing recommendations from the health department be documented, faxed to the physician, and a copy retained at the facility, but this process was not followed. The NP indicated that by the time the DPH recommendation was communicated, there were no longer residents with active GI symptoms under her care. The Administrator stated she did not know the type of virus present and confirmed that the report to DPH should have described the symptoms and treatment prescribed according to the physician’s orders. These actions and inactions resulted in the facility not implementing DPH’s recommended diagnostic testing for symptomatic residents during the outbreak.
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