F0773

D

Delay in Provider Notification and Treatment of Positive Urine Culture

Millsboro, Delaware Survey Completed on 08-25-2025

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to promptly notify the ordering practitioner of abnormal urine culture results for one resident. The resident was admitted to the facility and later complained of burning with urination. A nursing progress note documented that a urine sample was collected, an in-house dipstick was positive for blood and leukocytes, and a urinalysis and culture and sensitivity were ordered. The nurse documented that the NP was notified in the book, and a physician progress note confirmed that the urine had been picked up by the lab and that they were awaiting culture and sensitivity results. When the urine culture results became available, they showed a positive urinary tract infection with greater than 100,000 CFU of E. coli.

The clinical record lacked evidence that the positive urine culture and resulting UTI were addressed for three days after the results were available. A physician’s order for an oral antibiotic (cefuroxime axetil) was not written until several days after the positive culture result. The medication administration record then showed that the antibiotic was initially not available and was not administered until the following day. A nursing progress note indicated that the pharmacy did not process the cefuroxime due to a documented allergy and that doses were obtained from a local pharmacy, resulting in an additional one-day delay. Interviews with nursing staff and the unit manager revealed that outside lab urine culture results are automatically uploaded into the resident’s chart, that staff are expected to monitor the chart and notify the provider when results appear, and that the outside lab generally does not call for positive urine culture results. The unit manager confirmed there was a delay in notifying the provider about the culture results for this resident.