A resident with DM, anemia, and adult failure to thrive had signs and symptoms of UTI, and the physician ordered in and out urine collection for UA and C&S along with empiric Bactrim pending results. The LVN could not locate any UA/C&S results in the EHR or paper chart, and the IPN stated he did not know whether the catheterization was completed or follow up on whether the specimen was sent to the lab or the results were received. The DON stated nursing staff and the IPN were supposed to follow up to confirm the UTI diagnosis and guide antibiotic treatment.
A resident with hepatic encephalopathy, liver cirrhosis, and chronic kidney disease had a physician’s order for daily ammonia level testing, but the facility failed to obtain and submit blood specimens on multiple ordered days. The resident and a family member reported that tests were not being done at the facility and that the resident’s most recent ammonia level had only been checked at the hospital. Nursing staff acknowledged that nurses were responsible for drawing and delivering specimens to the hospital lab, documenting the draws, tracking results, and notifying management and the MD if unable to complete the tests. Review of records and confirmation from the outside laboratory showed no ammonia specimens were received from the facility on the missed days, confirming that the ordered daily labs were not carried out.
A resident with hypothyroidism, UTI, and DM had a physician order for T3, FT4, and TSH labs, but the tests were not completed and results were unavailable. The ADON stated there was no documentation of follow-up with the lab provider, and the DON noted the labs were needed to evaluate levothyroxine effectiveness and guide further interventions.
The facility failed to complete physician-ordered lab tests for two residents. One resident with CVA, hemiplegia, HF, and dementia had CBC and CMP orders that were not drawn, and another resident with CVA, HF, and DM had BNP and PT panel orders that were not drawn. RN stated the results were unavailable, and the DON stated ordered labs are important to establish a baseline and monitor residents' health conditions.
Failure to complete pharmacist-recommended lab work for a resident with dementia, muscle weakness, and COPD. The consultant pharmacist’s MRR recommended a CMP, CBC, and valproic level, but RN documentation showed the recommendations were not acknowledged and the labs were not drawn. The RN stated staff failed to carry out the recommendations and that the order request should have been placed to the physician.
The facility failed to ensure timely lab draws and results for four residents, including delayed C. diff stool testing after a change in bowel pattern, delayed STAT CBC/BMP/UA with C&S for a resident with UTI symptoms and hematuria, and repeated delays and communication problems around PT/INR monitoring for two residents on warfarin. Nursing staff documented multiple unanswered calls and faxes to the contracted lab, specimens that became non-viable or had to be redrawn, missing or incomplete requisitions, and PT/INR and urine culture results not returned within the facility’s stated expectations for STAT and routine testing. The DON and Administrator acknowledged that the new lab vendor was not meeting expected turnaround times and that there was no alternative lab arrangement in place, contributing to prolonged periods without needed lab information for these residents.
Failure to complete ordered monthly laboratory tests: A resident with bipolar disorder, epilepsy, and CHF had physician orders for monthly CBC, CMP, and Depakote levels, along with Depakote 125 mg BID. Record review and interview showed the labs were not drawn for two months, and there was no documentation that the MD was notified or that follow-up occurred with the lab. The ADON and DON confirmed the missed labs and stated the tests were needed to monitor the resident’s condition and Depakote therapeutic level.
A resident with severe cognitive impairment and multiple medical conditions did not receive physician-ordered lab tests, including CBC, CMP, and magnesium, due to staff failing to process the requisition and notify the physician of the missed tests.
A resident with multiple diagnoses, including cellulitis and cancer, did not receive a physician-ordered CBC with differential after the initial blood sample was unusable. Facility staff did not follow up with the laboratory to ensure the test was completed, resulting in the test not being performed as required by facility policy.
A resident with multiple medical conditions did not have a physician-ordered blood draw completed as scheduled. The lab service log indicated a refusal, but the resident denied refusing, and there was no documentation in the nursing notes to support a refusal. The LVN signed the log but did not document the event, and the DON confirmed that such refusals should be documented and the physician notified.
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