IDPH has cited and fined Tri-Stae Village Nursing & Rehab when a resident did not receive UTI medication for approximately nine days due to a lack of communication and follow-through by the facility staff.
The resident in question, a female with a diagnosis of dementia, had a urine analysis which showed positive nitrites and a cloudy appearance.
A day after the positive results a Nurse Practitioner ordered an IV antibiotic.
The urine culture, which was finalized five days later, revealed “greater than 100,000 col/ml Escherichia coli,” indicating a urinary tract infection (UTI). The owner of the lab confirmed that “the facility was made aware of the positive urine analysis and positive urine culture and sensitivity.”
Nine days after the IV antibiotics were ordered, the resident’s family requested that she be sent to the hospital due to her not responding to verbal commands as she usually does.
The hospital records indicate that the resident was admitted with sepsis, UTI, hypernatremia, acute encephalopathy, pulmonary issues, and hypokalemia. The records state, “female presents ER/emergency room from nursing home for altered mental status. She is tachycardic. She apparently was just diagnosed with UTI. She is septic from a UTI.”
The key piece in the equation is that the antibiotics that were ordered one day after the initial lab results were never administered.
The Nurse Practitioner that originally ordered the medication stated “I did not get a call from the facility stating that there was an issue with ordering the antibiotics, I did not get a call stating there was an issue with starting an IV on the resident either, I did not get a call stating there was an issue with the antibiotics that I had ordered for the resident. I was under the assumption that the medication had been started.”
A review of the resident’s progress notes revealed that at no point had the resident refused any medication.
A medical doctor expressed concern about the delay in treatment, stating, “My expectation is that the facility implements orders as prescribed. An untreated urinary tract infection can contribute to sepsis. Nine days is a long time for no treatment.”
In summary, the resident had a confirmed UTI and was subsequently admitted to the hospital nine days after the initial lab results and four days after the confirmation of the UTI. Despite having orders for IV antibiotics, the resident did not receive the prescribed medication for approximately nine days due to a lack of communication and follow-through by the facility staff, potentially contributing to her deteriorating condition and hospitalization.
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