Delayed Urine Specimen Collection and Prolonged UTI Symptoms
Penalty
Summary
The deficiency involves the facility’s failure to obtain a timely urine specimen and initiate prompt evaluation for a resident with a history of UTIs who was cognitively intact but physically dependent on staff for hydration and toileting needs. The resident had Parkinson’s disease, depression, muscle weakness, and contracted hands, and required staff to bring liquids and utensils to their mouth. During observation, multiple cups of water and food were placed out of the resident’s reach. The resident reported needing assistance with most activities, including eating and drinking, and stated they sometimes waited hours to be changed and experienced frequent UTIs. The complaint to the State Agency alleged it took over four days to obtain a urine specimen for suspected UTI and that staff attributed the delay to the resident not drinking enough water, despite the resident’s need for staff assistance with fluids and concerns about staff responsiveness to call lights. Record review showed that the resident first complained of mild pain with urination on 1/31, with this complaint documented on 2/1 and logged for MD follow-up. On 2/2, the NP documented dysuria and mild suprapubic tenderness, encouraged hydration, and ordered a UA with culture. Nursing notes on 2/2 and 2/3 documented attempts to obtain a urine sample, including straight catheterization with very limited backflow and a soaked brief, and the need to endorse the task to oncoming shifts. On 2/4, another unsuccessful attempt was documented, followed by an NP note the same day indicating an acute visit for UTI symptoms, suprapubic/flank tenderness, and collection of a cloudy, odorous urine sample via straight catheter. Nursing notes then documented that this urine sample, placed in the refrigerator, was mistakenly discarded and the need to endorse collection again to the next shift. Further attempts at straight catheterization on 2/5 were unsuccessful, and a positive UA was not documented until 2/7, with continued reports of suprapubic tenderness and burning on 2/11. In an interview, the DON acknowledged difficulty obtaining urine via straight catheter and could not explain why the collected specimen was discarded or the reason for the extended delay in obtaining a usable sample.
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