IDPH has cited and fined Momence Meadows nursing home after the staff failed to notify the resident’s doctor of a critically high lab value, resulting in the resident being sent to the hospital and placed on dialysis.
Doctors are not present in a nursing home on a 24/7 basis and when they are not there, one of the roles that the nurses play is to serve as “the eyes and ears” of the doctor. In that role, it is their job to notify the doctor when things occur like nursing home falls, the development of bed sores, and significant changes in the resident’s condition. One of the things that they are also responsible for is reporting when lab results show abnormal values. This allows the doctor to make a decision to issue orders over the phone, come into the nursing home to see the resident, or order the resident sent to the hospital.
This resident was admitted to the nursing home with an order to receive a powerful IV antibiotic called vancomycin in order to treat a cellulitis infection. Vancomycin is metabolized (or cleared) through the kidneys and when the kidneys are not clearing the vancomycin efficiently, then the vancomycin can cause significant injuries to the kidneys. Therefore, ongoing bloodwork is taken to melsasure the levels if vancomycin in the body. If the levels climb too high, the orders for the vancomycin can be changed to prevent injury to the kidneys.
In this case, the orders for this resident included giving three doses of vancomycin per day and then taking the resident’s vancomycin levels every third dose. On September 11, the lab results showed a vancomycin level of 65.6 (normal is 20-25). This a critically high level,
The pharmacy called the September 11 lab results into the nursing home, but the nurse did not call the doctor. The pharmacy did call the medical director who ordered that the vancomycin be held (not given) for a single dose on September 12 and then restarted on September 13. On September 11, the lab results showed a vancomycin level of 65.6 (normal is 20-25), a Blood Urea Nitrogen (BUN) level of 184 (normal 5-28) and creatinine level of 9.7 (normal 0.6-1.2). These are all critically high levels which called for physician notification. No one notified any of the doctors about the September 13 abnormal labs results until September 16, when the assistant director of nursing contacted the doctor regarding the abnormal September 13 lab results.
The wound doctor told the state surveyor that had he been notified of the abnormal lab results on September 13, he would have sent the resident to the hospital for treatment of vancomycin toxicity. The treating nephrologist told the state surveyor that the resident suffered acute kidney injury on top of chronic kidney disease and that she required dialysis and that it was not possible that time to tell whether the kidney injury was permanent.
There are a number of factors in play here, most notably the failure of the staff to notify the doctors involved of the abnormal lab results. The statement of the wound care doctor indicates that the resident should have been sent to the hospital much sooner which would have allowed for treatment of the vancomycin much sooner and likely would have resulted in less injury to the kidneys.
Past that, the role of the medical director deserves scrutiny. Medical directors are independent contractors and would face their own liability for the care they provide, and the decisions to not send the resident to the hospital after being advised of the September 11 critically high lab values and then restarting the vancomycin after holding a single dose should be closely reviewed. Further, the citation reflects that the vancomycin was ordered held on September 13 through September 18. It is unclear who issued this order, but the decision to simply hold the vancomycin when the lab values were so critically high also deserves serious scrutiny.
The citation reflects that there was no attempt to notify the doctors about these critically high lab values on and after September 13 up until the assistant director of nursing notified the doctor on September 16. Not surprisingly September 14 and 15 fall on a weekend when it is harder to keep the nursing home staffed as fully as it is during the week. One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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