IDPH has cited and fined Sandwich Rehab after it took 8 days to get test results s for a resident showing signs and symptoms of a urinary tract infection.
The resident at issue suffered from urinary retention, a condition where the bladder does not empty completely. To help the bladder empty, she was provided with an indwelling catheter. One of the risks associated with the use of a catheter is the development of a urinary tract infection.
Nurses are required to be able to identify signs and symptoms of a urinary tract infection. Some of the signs of a urinary tract infection in a resident with a catheter include cloudy or blood-tinged urine, strong smelling urine, burning at the catheter site, fevers, lower back pain, and generalized malaise. When a resident demonstrates signs and symptoms of urinary tract infection, they are required to notify the doctor.
In this case, on September 12, the resident complained of burning at the catheter site and lower body pain. The nurse caring for her did the right thing: she notified the doctor and obtained an order for a urinalysis with culture and sensitivity. This is a test which would confirm the the presence of the urinary tract infection and let the doctor know which antibiotics would be most effective in combatting the infection.
The nurse drew the urine sample that day, but the lab failed to pick the sample up. On September 15, another order was obtained from the doctor for a urinalysis with culture and sensitivity. It wasn’t until September 20 — 8 days after the test was ordered — that the results came back, and the doctor then ordered keflex (an antibiotic). During the interim, the infection progressed with the resident demonstrating additional symptoms of the urinary tract infection with sediment and blood in the urine, fevers, and chills. On September 22, she was admitted to the hospital with sepsis.
When IDPH came to investigate this incident, the facility’s Director of Nursing turned on the lab, telling the inspector, “Our lab is horrible, horrible!” (exclamatino point in the original), relating to the surveyor that the urine sample was taken on the 12th, but no one came that day to pick it up. A follow-up call was made on the 13th, but no one came. On the 15th, the Director of Nursing said she “threw a fit” and was promised that someone would be out that day but no one came until the 17th when a new urine sample was taken to the lab.
Obviously, a significant part of the blame here rests on the lab – it is their job to get the sample in a timely way. However, when the sample was not being picked up, more action than was taken was required; after all there was a resident with a serious illness.
Past that, this is a good example of how the decisions made by people at the business end of the nursing home industry impact the care that residents receive. Most often this is seen in nursing homes being understaffed. In this case, the people delivering the care are stuck working with a vendor (the lab) that isn’t getting the job done. The DON’s description of the lab (“horrible, horrible!”) tells me that this is probably not the first time that they have had problems with the work being done by the lab.
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