|§483.50(a)(2) The facility must-|
(i) Provide or obtain laboratory services only when ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws.
(ii) Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside of clinical reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician's orders.
Based on the review of facility policies, clinical record review and staff interviews, it was determined that the facility failed to ensure that resident's physician was notified about abnormal laboratory test results for one of four residents reviewed (Resident R1).
A review of facility's policy titled, "Test result" dated April 2017, revealed that "Result of laboratory, radiological, and diagnostic tests shall be reported to the resident's attending physician or to the facility. Should the test results be provided to the facility, the Attending Physician shall be promptly notified of the results. Signed and dated reports of all diagnostic services shall be made a part of the resident's medical record".
Review of the clinical record for Resident R1 revealed that resident was admitted to the facility on June 8, 2019 with diagnosis including but not limited to muscle weakness, history of falls and urinary tract infection.
Review of nursing note documentation dated September 8, 2019, revealed that the resident had increased frequency of urination and strong odor to the urine. Continued review of the nursing note revealed that a physician's order for urine analysis and urine culture sensitivity (a set of urine test which diagnose diseases such urinary tract infection) was obtained.
A review of the laboratory results for Resident R1 dated September 10, 2019 revealed an abnormal urine test result which indicated "10,000-100,000 mixed organisms-probable contamination." Review of entire clinical record for Resident R1 revealed no documented evidence that the attending physician was notified of the urine test result.
Further review of Resident R1's laboratory studies revealed the results of a urine test collected on September 12, 2019 which indicated "greater than 100,000 mixed organisms-probable contamination." Review of entire clinical record for Resident R1 revealed no evidence that a physician's order was obtained for this urine test. Further there was no evidence in the clinical record that the resident's physician was notified of the urine test result of September 12, 2019.
An interview with director of nursing on September 20, 2019 at approximately 3:00 p.m. confirmed that resident clinical record did not contain any evidence that physician was promptly notified of the urine test results dated September 9, 2019 and September 12, 2019.
Facility failed to ensure that resident's physician was promptly notified about abnormal test results.
28 Pa. Code 211.12(d)(3)(5) Nursing services.
Previously cited 6/27/19, 4/25/19, 3/8/19, 12/13/18,
| ||Plan of Correction - To be completed: 10/24/2019|
The submission of this response to the statement of deficiencies by the undersigned does not constitute an admission that the deficiency existed and/or required correction. This response is prepared, executed and submitted solely as a requirement of the provisions of federal and state law.
It is the practice of the facility to notify the resident's physician of any abnormal laboratory test results.
-The physician was notified of the abnormal test results for Resident R1.
-Other residents will reviewed to ensure the physician is notified of abnormal test results.
- Education will be completed by DON/Designee with current licensed nurses to ensure that physicians are notified of a resident's abnormal test results.
-The DON/Designee will complete a weekly random audit for 3 months to verify that physicians are being notified of a resident's abnormal test results. Results of audits will be discussed and reviewed at the facility QAPI meeting to ensure compliance. QAPI committee members will review to discuss need for further audits.
-To be completed by 10/24/2019.