Delayed Initiation of Antibiotic Therapy for Residents With Positive Urine Cultures
Penalty
Summary
The deficiency involves the facility’s failure to timely initiate antibiotic therapy for residents who met minimum criteria for treatment of urinary tract infections (UTIs) based on positive urine cultures. One resident with a thoracic spinal cord injury and an indwelling urinary catheter had a urinalysis and urine culture obtained after reporting urinary discomfort. The hospital lab received the specimen and, on the following day, reported abnormal urinalysis findings including cloudy urine, moderate blood, positive nitrates, and large white blood cells, along with an E. coli count greater than 100,000 cfu/ml, which was filed to the resident’s chart as a positive urine culture. Susceptibility results were filed the next day. Despite these findings, the facility did not obtain an order for antibiotic therapy until two days after the positive culture and abnormal urinalysis results were available, even though the resident met the minimum criteria for initiating antibiotics as a catheterized resident. A second resident with spastic quadriplegia cerebral palsy had a urinalysis and culture ordered for altered mental status. The urine specimen was obtained and received by the lab the same day, and the next day a faxed lab report showed a Proteus mirabilis colony count greater than 100,000 cfu/ml, indicating a positive urine culture. Culture sensitivity results were reported to the facility the following morning. However, an antibiotic order was not documented until later that same day, resulting in a delay in initiating antibiotic therapy after the resident had already met the minimum criteria for treatment as a non-catheterized resident. Interviews with nursing and lab staff confirmed that lab results are faxed or uploaded to the chart and that any nurse can contact the physician with results, but in both cases antibiotics were not started when the positive culture criteria were first met.
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