F0770

D

Failure to Timely Obtain Ordered C. diff Stool Testing

Clemmons, North Carolina Survey Completed on 02-13-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to obtain a timely ordered Clostridium difficile (C. diff) stool test for a resident with a history of C. diff infection who was experiencing abdominal tenderness and loose stools. The resident was admitted from a hospital with multiple diagnoses including declining functional status, pulmonary embolism, prior vaginal and rectal bleeding secondary to anticoagulant use, past C. diff infection, right hip osteoarthritis, depression, anxiety, obstructive sleep apnea, and generalized weakness. On 12/29/25, a provider documented abdominal tenderness on exam and ordered stool testing for C. diff. Bowel and bladder records showed a loose stool on 12/31/25, but there was no documented collection or result of a C. diff stool test following this order.

In early January, the resident continued to have loose stools. A 1/2/26 provider note referenced multiple recent loose stools and indicated that the resident’s abdominal pain had resolved, with notation that stool testing for C. diff was still pending. Bowel and bladder records documented loose stools on 1/4/26 and 1/6/26, on days when Nurse #4 was assigned to the resident; however, Nurse #4 later reported being unable to recall the resident or why a stool sample was not collected on those dates. Laboratory records from 12/31/25 through 1/7/26 showed no C. diff stool result. A second order for C. diff stool testing was placed on 1/7/26, but again, no stool result was documented between 1/7/26 and 1/14/26.

A third order for C. diff stool testing was placed on 1/11/26. On 1/8/26, the provider documented occasional loose stools, a history of diarrhea controlled with loperamide, and noted that the ordered C. diff stool had not yet been collected, despite having spoken with nursing staff and verbally requested collection. On 1/15/26, the provider documented that the resident appeared uncomfortable, reported stomach pain prior to bowel movements that was sometimes relieved afterward, and continued to have loose stools, with physical exam showing dull, nonspecific abdominal tenderness and active bowel sounds. The stool specimen was finally collected on 1/15/26, and on 1/16/26 the result was positive for C. diff. Interviews with nursing staff, the Physician Assistant, the DON, the Regional Nurse Consultant, and the Administrator confirmed that the expectation was for stool samples ordered for C. diff testing to be collected as soon as possible, but in this case the ordered testing was not obtained until after multiple orders and ongoing loose stools.