Health inspection·June 24, 2022

F773 §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. §72311 Nursing Service - General (a) Nursing service shall include, but not be limited to, the following: (3) Notifying the attending licensed healthcare practitioner acting within the scope of his or her professional licensure promptly of: (B) Any sudden and/or marked adverse change in signs, symptoms or behavior exhibited by a patient. On 04/13/2022, the Department received a complaint regarding a resident (Resident 4) whose abnormal lab work was not reported to the physician. On 4/14/2011, an unannounced investigation was conducted at the facility. Based on observation, interview, and record review, the facility failed to: 1. Ensure Resident 4’s abnormal urinalysis test results were relayed to the physician timely as required by their policy and procedure, "Lab and Diagnostic Test Results - Clinical Protocol" and regulations. As a result of this deficient practice there was a delay in diagnosis and treatment of Resident 4's urinary tract infection (UTI, happen when bacteria, often from the skin or rectum, enter the urethra (the tube that allows urine to pass out of the body), and infect the urinary tract).   Resident 4 was transferred to the acute hospital and was diagnosed and treated for two days for urosepsis (an untreated UTI that spreads to the kidney, an organ that filters blood to remove wastes and extra water to make urine). A review of the Admission Record indicated Resident 4 was initially admitted to the facility on 10/29/2001 and readmitted on 5/6/2020, with diagnoses that included obstructive and reflux uropathy (urine cannot flow either partially or completely through the ureter (The tube that carries urine from the kidney to the bladder), bladder (an organ in the body resembling a pouch into which urine passes from the kidneys and is temporarily stored until discharged from the body), or urethra due to some type of obstruction and a condition in which the kidneys are damaged by the backward flow of urine into the kidney), quadriplegia (paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso), and constipation (a condition in which there is difficulty in emptying the bowels, usually associated with hardened feces). A review of Resident 4's Minimum Data Set ([MDS] a standardized assessment and screening tool) dated 1/18/22, indicated Resident 4 had intact cognition (ability to think, understand, and reason) required extensive assistance with bed mobility, dressing, and personal hygiene, and was totally dependent in toilet use.  The MDS indicated Resident 4 had an indwelling suprapubic urinary catheter (a tube placed in the abdomen of the body to drain and collect urine from the bladder). A review of the Nursing Progress Notes dated 4/11/2022 (late entry entered by Licensed Vocational Nurse 5 (LVN 5) indicated, on 2/22/22, Resident 4 verbalized a complaint of lower abdominal pain, and appearance of suprapubic catheter output, urine was noted as cloudy, with leakage at the catheter site. The Nursing Progress Notes indicated the attending physician was notified, and an order was obtained to complete a urinalysis test ([UA] examinations of the physical and chemical properties of urine and its microscopic appearance to aid in medical diagnosis) and orders were noted and carried out. A review of the Physician's Order Summary dated 2/22/22, at 2:29 p.m., indicated, Resident 4 had an order to obtain a urinalysis (UA) for one time only. A review of the results of the UA Laboratory Report dated 2/23/22 at 3:15 a.m. indicated the increased white blood cell count ( WBC, the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders) measured 29 WBC per high power field (HPF) (normal range 0-2 WBC per HPF, [the presence of five or more WBCs in the urine indicate a urinary tract infection involving the bladder, kidney or both]) and had the presence of leukoesterase ( a substance that suggest there are WBCS in the urine), nitrite (substances that suggest UTI) and small bacteria (microscopic living organisms that can be dangerous and cause infections). The laboratory report results were reported to the facility on 2/23/22 at 2:12 p.m. The laboratory report indicated the results were reported to the resident's physician on 2/28/22 (handwritten), five days later the result reported and new order to transfer the resident to the general acute care hospital (GACH). A review of the GACH's Discharge Summary dated 3/2/22, indicated, Resident 4 was admitted to the hospital on 2/28/2022, with a chief complaint of urinary tract infection, flank tenderness (discomfort or pain may be present in the back (lower or middle) and/or the suprapubic area), and an elevated WBC. The record further indicated Resident 4 had been complaining of back pain with fever, chills, and shakes.  The reason for Resident 4's admission was urosepsis. According to the GACH's course and treatment Resident 4 was found to have a urinary tract infection and was administered the following antibiotics: 1.Empiric piperacillin (antimicrobial therapy directed against an anticipated and likely cause of infectious disease).  2.Tazobactam (Antibiotic, inhibits the growth of or destroys bacteria) 3.375 grams (gm, a unit of measure) intravenously (administer into the vein) once.  3.Amikacin (Antibiotic) 500 milligrams per milliliter (mg/mL, a unit of measure) was started via intravenous (IV) every eight (8) hours. A review of the GACH's Discharge to skilled nursing facility order dated 3/1/22, indicated, Resident 4 was discharged back to the facility with an order to administer oral Macrobid 100 (antibiotic, works by killing the bacteria that cause urinary tract infections (UTIs) in the urethra, bladder, and/or kidneys) 100 milligrams (mg, a unit of measure) by mouth twice a day for ten days.  During an interview on 4/14/22, at 9:14 a.m., with Licensed Vocational Nurse 6 (LVN 6), LVN 6 stated, on 2/28/22, Resident 4 asked for his laboratory result which was collected on 2/23/22. LVN 6 noted there were abnormal laboratory results of the UA test.  LVN 6 stated she notified the physician of the resident's results immediately and obtained an order to transfer the Resident 4 to the hospital for possible sepsis (a potentially life-threatening condition that occurs when the body's response to an infection damages its own tissues). During an interview with LVN 5 on 4/14/22, at 12:43 p.m., LVN 5 stated, if there was an abnormal finding on a resident's laboratory results, the charge nurse or supervisor needs to inform the attending physician right away.  LVN 5 stated the charge nurse was supposed to notify the physician the same day the laboratory results were received. LVN 5 stated if there is a delay in notifying the physician of abnormal laboratory results, there is a potential for harm that could worsen the resident's health. LVN 5 stated, "I am not sure why the results for the urinalysis for Resident 4 were reported late." During a concurrent observation and interview on 4/14/22, at 12:27 p.m., with Resident 4, in the resident's room, Resident 4 was observed to have a urinary catheter. Resident 4 stated, on 2/28/22, he was feeling pain in the pit of his stomach and stated that whenever he felt that pain, he knows it's a UTI. Resident 4 stated that he reported the pain to LVN 5 on 2/22/22 and 2/28/22, but the nursing staff did not inform him of his urinalysis results (test taken on 2/22/22) until he asked LVN 6.  Resident 4 stated after he was informed of his urinalysis results (2/28/22), he was transferred to the hospital where he received antibiotics for his UTI. During an interview on 4/14/22, at 1:21 p.m., with Certified Nurse Assistant (CNA) 4, CNA 4 stated part of his job is to report what the residents' complained about to the charge nurse and there have been several occasions where Resident 4 had expressed he was in pain and LVN 5 did not help him. During an interview on 4/14/22, at 1:50 p.m., with the Director of Nursing (DON), DON stated, when there are abnormal laboratory results or critical laboratory results, the physician is to be informed right away by whoever received the laboratory results. DON stated, "Ultimately it is the responsibility of the charge nurse to report abnormal findings, that is why they are the charge nurse because they are in charge of the residents on the shift they are working." During a review of the facility's policy and procedure (P&P) titled, dated October 2016, indicated a nurse will review all results. If the staff who first received or reviewed the lab and diagnostic test result cannot follow the remainder of this procedure for reporting and documenting the results and their implications, another nurse in the facility (supervisor, charge nurse, etc.) should follow or coordinate the procedure.  The policy further indicated a nurse will identify the urgency of communicating with the Attending physician based on the physician's request, the seriousness of any abnormality, and the individual's current condition. The facility failed to promptly notify the physician of the abnormal urinalysis (a test of your urine) results for Resident 4.  The facility did not notify the physician until five days after the abnormal urinalysis results had been reported.  As a result of this deficient practice there was a delay in diagnosis and treatment of Resident 4's urinary tract infection.  Resident 4 was transferred to the acute hospital and was diagnosed and treated for two days for urosepsis. These violations jointly, separately, or in any combination, presented either imminent danger that death or serious harm would result or substantial probability that death or serious physical harm would result to Resident 4.