cms_ND: 21
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 21 | THE MEADOWS ON UNIVERSITY | 355024 | 1315 S UNIVERSITY DR | FARGO | ND | 58103 | 2019-05-16 | 690 | G | 1 | 1 | FA2L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, the facility failed to ensure appropriate treatment and services to treat a urinary tract infection [MEDICAL CONDITION] for 1 of 4 sampled residents (Resident #30) with an indwelling urinary catheter. Failure to adequately monitor and promptly treat Resident #30's UTI resulted in an admission to the hospital for [MEDICAL CONDITION] work up, including continuous bladder irrigation (CBI) and treatment with intravenous (IV) antibiotics. Findings include: Review of Resident #30's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. Nurses' notes identified the following: *02/22/19 at 10:48 p.m.: . New order from (nurse practitioner) on call for (primary medical doctor) ordered a UA/UC (urinalysis/urine culture) for blood in urine and low grade temp (temperature) of 99.9 this shift. Foley changed. Foley was clogged with dried blood and urine was bright red. New foley inserted and N[NAME] (night) nurse was updated and will collect UA/UC. *02/23/19 at 2:29 a.m.: . Resident noted to have cherry red returns from catheter bag. This writer adjusted tubing and noted the urinary returns lighten up to pink. last shift had replaced catheter and noted hematuria. *02/23/19 at 4:30 a.m.: . Resident noted to have cherry colored urine in foley bag. Specimen was sent to lab. Last nurse had noted clots after removing old catheter. *02/24/19 at 12:16 a.m.: . Urine in Foley bag continues to be reddish colored. No clots noted. *02/24/19 at 10:29 p.m.: . Resident continues to have reddish brown urine. *02/25/19 at 12:12 a.m.: . Urine in Foley bag less red tonight. *02/25/19 at 3:30 p.m.: . resident continues to have blood in urine and (physician's assistant) called and update order to do CBC (complete blood count) and BMP (basic metabolic panel) note sent ton (sic) the lab. *03/02/19 at 9:32 p.m.: . Tylenol Tablet 325 mg (milligrams) Give 2 tablet by mouth every 4 hours as needed for pain/fever . Per request back et leg pain rated 6/10. *03/03/19 at 2:15 p.m.: . Noted urine remains red in Foley collection bag. Writer called (physician's assistant) at this time et (and) above information given. Orders received for CBC with diff (differential) et BMP tomorrow a.m. (gross hematuria). Lab request faxed to (name of lab) . *03/03/19 at 2:36 p.m.: . resident foley catheter was change (sic) due to it (sic) urine leakage, urine was bloody, will continue to monitor . *03/03/19 at 7:15 p.m.: . Urine continues to be bloody red in color in Foley collection bag. Writer called (physician's assistant) at this time et updated, requested resident be seen in (hospital name) ER (emergency room ). Order received to transfer resident . Ambulance took resident at 8 p.m. *03/03/19 at 11:38 p.m.: . admitted to hospital . *03/07/19 at 6:04 p.m.: . readmitted today via stretcher from (hospital name) following hospitalization [MEDICAL CONDITION]. Antibiotics are complete. The record lacked evidence of monitoring/assessment/communication regarding Resident #30's condition after the provider ordered labs on 02/25/19 until staff contacted him again on 03/03/19 (six days later, and nine days after staff first noted blood in Resident #30's urine). Resident #30's lab results showed staff collected a UA/UC on 02/23/19 at 4:20 a.m., with results faxed to the facility on [DATE] at 5:10 a.m. UA results showed: *Urine clarity as cloudy (reference range: clear) *Leukocyte Esterase (an enzyme found in white blood cells which can indicate infection) as large (reference range: negative) *Elevated white blood cells (WBC) (can indicate infection) at >= 50 (reference range: negative, 0-2, 3-5) *Elevated red blood cells (RBC) (can indicate infection, bleeding, or trauma) at >=50 (reference range: negative, 0-2) *Elevated bacteria at Moderate (31-50) (reference range: negative, rare (0-5), or few (6-30)) The preliminary UC results, faxed to the facility on [DATE] at 1:40 p.m., showed the presence of [DIAGNOSES REDACTED] pneumoniae at 30,000 CFU/ml (colony-forming units per milliliter, less than 10,000 CFU/ml is considered normal) The final UC with sensitivity results, faxed to facility on 02/25/19 at 1:40 p.m., showed: *30,000 CFU/ml [DIAGNOSES REDACTED] pneumoniae * *With susceptibility (i.e., would inhibit the growth of the bacteria) to the following antibiotics: [MEDICATION NAME]/clavulanate, [MEDICATION NAME], [MEDICATION NAME], and [MEDICATION NAME]/[MEDICATION NAME] The CBC, collected on 02/26/19 at 6:19 a.m. with results faxed to the facility on [DATE] at 9:09 a.m., showed the following results: *Elevated WBC at 12.1 (reference range 4-11) *Low RBC (can indicate blood loss) at 4.03 (reference range 4.4-5.8) *Low Hemoglobin (HGB) (can indicate blood loss) at 11 (reference range 13.5-17.5) *Low Hematocrit (HCT) (can indicate blood loss) at 34.2 (reference range 40-50) The above lab reports were signed off on 03/04/19 (the day after Resident #30 was admitted to the hospital). The record lacked evidence staff reviewed the labs prior to this day or communicated results to Resident #30's provider. The hospital progress notes identified the following: *03/04/19 at 1:25 a.m. (admission note): . REASON FOR ADMISSION: hematuria (blood in the urine), lactic acidosis (a buildup of [MEDICATION NAME] in the bloodstream) . sent from NH (nursing home) due to hematuria which has been present for the past 1 day. workup in ER shows elevated WBC and lactic acid. hgb (hemoglobin) is down from oct (October) (YEAR). Pt is admitted for further workup [MEDICAL CONDITION]. Last Vitals: . BP (blood pressure) 86/49 . Recent Results (from the past 24 hour(s)) . WBC 18.7 (increased from 12.1 on 02/26/19) . RBC 3.83 (decreased from 4.03 on 02/26/19) . HGB 10.2 (decreased from 11 on 02/26/19) . HCT 32.3 (decreased from 34.2 on 02/26/19) . Assessment/Plan . Hematuria - urology consult .[MEDICAL CONDITION] .[MEDICAL CONDITION] protocol monitor lactic acid, continue [MEDICATION NAME] ([MEDICATION NAME]) until cultures available . *03/04/19 at 8:16 a.m. (urologist note): . Impression: hematuria . Most likely hemorrhagic [MEDICATION NAME] . Plan: . When he is discharged we will set up cysto (cystoscope) as out pt . *03/04/19 at 10:58 a.m. (hospitalist note): . The patient's catheter has been leaking this morning and he has dark red hematuria. Per nursing, patient was oriented to person but currently is orientated x 0. Unable to perform ROS (review of systems): mental status change . Assessment/Plan: Principal Problem:[MEDICAL CONDITION] . Elevated WBC 18.7, Lactic acid 2.4, [MEDICAL CONDITION] 92/58. UA showed elevated WBC >182 indicating likely UTI. Patient continues to be hypotensive with min (minimum) BP 71/45. Typically BP has been 90s/50-60s. [MEDICATION NAME] is low 2.1 replacement may help BP. Plan . [MEDICATION NAME], IV [MEDICATION NAME] x1, IVF (IV fluids) . Hematuria . Plan . Catherer (sic) has been replaced, Urology consulted, continue antibx (antibiotics) to treat UTI, IVF . *03/06/19 at 10:49 a.m. (hospitalist progress note): . admitted for Heavy hematuria + elevated wbc's, urology did see him for foley placement and heavy hematuria, currently he is getting CBI (continuous bladder irrigation), received IV [MEDICATION NAME] one dose on 03/04/19 to help his [MEDICAL CONDITION] + [MEDICATION NAME] (low [MEDICATION NAME]). Assessment/Plan . Principal problem: 1) Acute complicated UTI . Stable, improving .[MEDICAL CONDITION]: Clinically undetermined if he was [MEDICAL CONDITION] or not - resolved . [MEDICAL CONDITION] on admission time was not due [MEDICAL CONDITION], it was due to a lack of po (oral) intake + [MEDICATION NAME]: resolved post IV [MEDICATION NAME] and IV fluids, b/p continues to be stable . Confusion on 03/03/19 due to UTI c/w (consistent with) Toxi(c) metabolic [MEDICAL CONDITION] (an acute mental status change often caused by electrolyte imbalance or infection): resolved - he is back to his baseline . Gross heavy hematuria . outpatient follow up with cystoscope with Urology . *03/06/19 at 11:46 a.m. (infectious disease consult): . was admitted with heavy hematuria status [REDACTED]. On admission the urine culture is now growing [DIAGNOSES REDACTED] pneumonia and [MEDICATION NAME] species. Initially he had a very elevated white blood cell count and altered mental status but now seems to be returning back to his baseline, still on CBI but urine has cleared completely, and leukocytosis (elevated WBC) has resolved. He has received a total of 3 days of high-dose [MEDICATION NAME] ([MEDICATION NAME]). Discharge instructions, dated 03/07/19, identified a follow up urology appointment scheduled for 03/18/19. Review of Resident #30's medical record identified the resident did not go to this appointment. When asked for information regarding the above, the facility provided no additional information. The facility failed to provide appropriate monitoring and assessment of Resident #30's condition, failed to promptly monitor lab results and recognize abnormal values, and failed to communicate adequately with the provider which resulted in a deterioration in Resident #30's condition, delayed treatment for [REDACTED]. The facility also failed to provide follow up care after this hospitalization . See F658. | 2020-09-01 |