Failure to Implement Hospital Discharge Orders for UTI Treatment
Penalty
Summary
The deficiency involves the facility’s failure to ensure continuity of care and timely implementation of hospital discharge orders for a resident treated for an acute urinary tract infection (UTI). The resident, who had vascular dementia, kidney and ureter disorders, a kidney cyst, a history of UTIs, and frequent urinary and bowel incontinence, was moderately cognitively impaired and required substantial assistance with toileting. A hospital after visit summary (AVS) documented diagnoses of kidney stone, kidney cyst, and acute UTI, with instructions to initiate cephalexin 500 mg by mouth four times daily for seven days following a dose of Rocephin. The hospital record also noted a left renal calculus with partial obstruction and abnormal urinalysis findings. Upon the resident’s return to the facility, a progress note recorded the readmission, but from that date until three days later there was no documentation of refusal of care or refusal to provide the AVS. The physician order for cephalexin 500 mg four times daily for seven days was not created until two days after the resident’s readmission, and the medication administration record showed the antibiotic was not started until that later date, with the first dose given upon rising. A registered nurse interviewed denied knowledge of the resident’s UTI or the need for antibiotic therapy upon readmission. The DON stated that the resident had refused to provide the AVS, but confirmed there was no documentation of such refusal and no evidence that staff attempted to obtain the AVS from the hospital or contact the resident’s power of attorney, who had been present at the time of hospital admission. The DON also confirmed that the resident returned with a diagnosis of acute UTI and an order to start cephalexin four times daily, which was not initiated until days later, and was unsure if the antibiotic was available in the emergency box. In contrast, the resident reported being welcoming and denied refusing to give staff the hospital AVS.
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