Failure to Complete Ordered Laboratory Tests for Resident With Hyperparathyroidism
Penalty
Summary
The facility failed to ensure ordered laboratory tests were completed and followed up for a resident with hyperparathyroidism and elevated calcium levels. Facility policy required that laboratory services ordered by a provider be obtained, that results and pending or missing labs be included in shift report, and that pending or missing labs be followed up in daily clinical meetings. The resident, admitted with Parkinson’s disease and hyperparathyroidism and documented cognitive impairment, had a calcium level of 12.2 (normal 8.6–10.2). A provider ordered PTH, vitamin D, and ionized calcium testing, but laboratory results for that date showed PTH and ionized calcium were not performed because no specimen was received. A subsequent provider note documented that PTH and ionized calcium had not been performed and were reordered. A later physician order again directed that PTH and ionized calcium be obtained, but laboratory results again showed these tests were not performed due to no specimen being received. Another order was written for a CBC and CMP, and on that date the lab called the facility with a critical calcium value, after which the resident was transferred to the hospital. Hospital records documented a calcium level of 17 and admission for acute pulmonary embolism, aspiration pneumonia, and hypercalcemia. During interview, the Administrator acknowledged that the resident had provider orders for PTH and ionized calcium on two separate dates, that the lab indicated specimens were not obtained on those dates, and that nursing was responsible for ensuring labs were collected, sent, and results received as ordered.
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