Failure to Complete Ordered Labs and Wound Culture Timely
Penalty
Summary
The deficiency involves the facility’s failure to ensure ordered laboratory tests and wound cultures were completed in a timely manner for one resident. The resident was admitted with multiple serious diagnoses, including a right humerus fracture, wedge compression fracture of the second lumbar vertebra, multiple rib fractures, thrombocytopenia, and hypertension, and was later discharged. Physician orders dated on one occasion directed that a complete blood count (CBC) and basic metabolic panel (BMP) be obtained, but review of the medical record showed no evidence these blood tests were ever completed. A provider progress note confirmed that the labs ordered on that date were not done. A subsequent physician order for a CBC and BMP was carried out, and those labs were completed as ordered. The facility also failed to complete a wound culture and sensitivity as ordered in a timely manner. A physician ordered a wound culture and sensitivity, and a specimen was collected and reported by the laboratory. However, the lab report indicated the test was not performed due to specimen integrity issues, specifically that the facility had submitted an expired swab and was instructed to recollect a new specimen. The medical record contained no documentation that a repeat wound culture was obtained following this notification. A later physician order for a wound culture and sensitivity was eventually carried out, with the culture collected on a later date. In an interview, the DON verified that the ordered labs from the earlier date were not completed and confirmed that the wound culture specimen had been collected with an expired swab and was not recollected until a later date.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.