Health inspection·November 14, 2023

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, staff interviews, and policy review the facility failed to obtain the results and promptly notify the provider of an abnormal urine culture resulting in a delay in treatment for 1 of 3 sampled residents reviewed for urinary tract infection. (Resident #2) The findings include: A review of Resident #2's paper and electronic medical record revealed the resident was examined by the Advanced Practice Registered Nurse (APRN) on [DATE] at 5:45 PM. The examination note revealed the family was concerned about the resident having increased drowsiness during the day and the facilty nurse reported some episodes of tachycardia. Respirations were elevated and even while resting. She was noted as continuing to decline. The current plan indicated orders for laboratory studies to include urinalysis with culture and sensitivity, comprehensive metabolic panel, platelets, magnesium, complete blood count, thyroid stimulating hormone, and a chest x-ray. Review of nursing notes: • The nurse's notes dated [DATE] indicated the labs were obtained that morning. • The nurse's notes dated [DATE] indicated the urine culture results revealed contamination and would need to be obtained again. • The nurses note dated [DATE] indicated another urinalysis for culture and sensitivity was obtained and sent to the laboratory at the hospital. The record revealed the resident received Bactrim DS antibiotic by mouth daily since her admission on [DATE] for urinary tract infection prevention. • The nurse's notes dated [DATE] at 7:00 PM indicated the resident had a temperature of 99.7. The family visiting reported resident had an occasional cough and was not feeling well. Page 1 of 3 105637 105637 11/14/2023 Marianna Health and Rehabilitation 4295 5th Avenue Marianna, FL 32446

F 0773 • Level of Harm - Minimal harm or potential for actual harm The nurse's notes dated [DATE] at 9:00 PM indicated the resident had a non-productive cough, a temperature of 99.4, and the resident was hallucinating about speaking to her mother. The physician was contacted and advised to retest the resident for COVID-19 in the morning. The resident was tested for COVID-19 on the morning of [DATE] and was negative. Residents Affected - Few • The nurse's notes dated [DATE] at 1:00 AM indicated the resident continued to have a non-productive cough and a temperature of 99.0 with continued hallucinations of speaking to her mother and father. • The nurses note dated [DATE] at 2:00 PM indicated the resident had been extremely fretful and the resident's daughter reported she had been calling out to past family members, awaiting a response from the physician. A physician order dated [DATE] indicated send resident to the hospital. • Review of the resident record on [DATE] during the survey revealed no result from the urinalysis culture obtained on [DATE]. The facility contacted the laboratory on [DATE] and obtained the result of the urinalysis culture dated [DATE]. Review of the urinalysis culture report dated [DATE] revealed the urine was positive for Escherichia coli and Proteus mirabilis and both organisms were resistant to Bactrim DS. The electronic culture report indicated it was reviewed by the APRN on [DATE] at 8:26 AM. The record revealed no additional antibiotic or treatment was ordered for the positive urine culture while the resident was in the facility. A review of the resident's hospital records dated [DATE]-[DATE] revealed a discharge summary by the physician dated [DATE]. The discharge summary indicated the resident was admitted to the hospital on [DATE] and expired in the hospital on [DATE]. The admission diagnoses were: altered mental status, COVID with concomitant pneumonia, hypoxia, urinary tract infection, coronary artery disease, and anemia. The discharge summary indicates the cause of death was presumed sepsis of a urinary source coupled with COVID positive pneumonia and a background history of Alzheimer's dementia. She was admitted , placed on Maxipime (an antibiotic) in addition to treatment with remdesivir (a medication for treatment of COVID-19) and some intravenous fluids. She had been placed on oxygen and ultimately required more of that as her stay progressed. Urine cultures returned positive for multiple organisms including Escherichia coli and Proteus. Eventually after some discussion, the family decided to make her simply care and comfort measures. Review of the hospital admission history and physical documented by the physician [DATE] revealed the resident has been deteriorating fairly rapidly over the last 4 to 6 months. According to family, within the last 2 or 3 days, she had substantial changes with altered mental status and not being able to recognize family, which was unusual for her. She had not been eating at all or taking any fluids. Of note, her roommate had tested positive for COVID, but for 3 consecutive days Resident #2 had not. Nonetheless, upon arrival to the Emergency Room, she was found to be altered with positive COVID and urinary tract infection and she was admitted for management, oxygenation, and intravenous antibiotics. An interview was conducted with the Director of Nursing (DON) on [DATE] at 3:09 PM. The DON stated 105637 Page 2 of 3 105637 11/14/2023 Marianna Health and Rehabilitation 4295 5th Avenue Marianna, FL 32446

F 0773 Level of Harm - Minimal harm or potential for actual harm the facility staff called the lab on [DATE] to obtain a copy of the urine culture lab report as stated in the progress notes, but the lab did not send a copy of the urine culture result. She confirmed the facility did not obtain a copy of the urine culture result for Resident #2 until today ([DATE]). The DON stated the floor nurse, or the unit manager, is responsible for ensuring laboratory results and culture results are received back from the laboratory and reported to the provider. Residents Affected - Few An interview was conducted with Employee A (Licensed Practical Nurse unit manager) on [DATE] at 11:03 AM. She stated it was each nurse's responsibility to ensure they receive pending laboratory results. She stated they document the laboratory tests on a checklist log and check them off when received. She provided the laboratory log for [DATE]. The urinalysis with culture and sensitivity for Resident #2 was listed on [DATE] as obtained but the results received area of the log was blank. She stated it was both the floor nurse and unit manager's responsibility to ensure the results were obtained and reported to the physician. A telephone interview was conducted with the APRN on [DATE] at 12:38 PM. She stated she had no recollection of reviewing the urine culture report dated [DATE] for Resident #2. She stated the resident was declining and at the end of life. She felt for some time hospice should be considered. The resident had an abnormal chest computed tomography scan and the family refused a biopsy. She stated the resident was taking a prophylactic antibiotic for prevention of urinary infections and she would not prescribe additional antibiotics without a culture unless the resident was really symptomatic. She felt the resident's decline could be attributed to a possible lung malignancy. Review of the facility policy for Test Results (Version 1.0 H5MAPL0881 revised [DATE]) revealed the policy stating, The resident's Attending Physician will be notified of the results of diagnostic tests. Results of laboratory, radiological, and diagnostic tests shall be reported in writing to the resident's Attending Physician or to the facility. The Director of Nursing Services, or Charge Nurse receiving the test results, shall be responsible for notifying the Physician of such test results. Signed and dated reports of all diagnostic services shall be made a part of the resident's medical record. 105637 Page 3 of 3