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Based on review of patient medical records, infection control reports and interviews, the facility failed to ensure that patients seen in the Emergency Department (ED) received the appropriate care and services to meet their needs after being discharged for 2 of 8 closed medical records reviewed (Patient #2 and Patient #3).

The findings include:

The following interviews were conducted with hospital staff regarding the facility's process for obtaining and reviewing culture and sensitivity reports for patients diagnosed with Urinary Tract Infections and discharged from the Emergency Department with reports pending.

On 04/25/2019 at 10:30 AM, an interview was conducted with the Manager for Lab Services. The Manager stated that urine culture and sensitivities (C&S) were collected and sent to another lab for analysis and reporting with a typical 3-4 day turn-around time for C&S results. The manager stated that once the results were received, a lab member printed outs a copy of the report for medical records, the infection control nurse and the Emergency Department provider.

On 04/25/2019 at 10:40 AM, an interview was conducted with the Infection Control Nurse (ICN). The ICN indicated that she was notified when a physician ordered cultues or antibiotics and stated that a copy of lab print outs for all culture results for patients seen in the ED were put in her box and she reviewed them as well. She stated that patients with culture orders were documented on the "Infection Control ER - Patient Surveillance Form" and that part of her duties included making sure the patient was on the right antibiotic, but stated usually the provider would contact the patient.

On 04/25/2019 at 10:55 AM, an interview was conducted with the Advanced Registered Nurse Practitioner (ARNP) - a Provider in the Emergency Department. The ARNP stated she normally worked during the day and was the one responsible for reviewing lab results, to include C&S reports received for Emergency Department patients. The ARNP stated she had a box in the Emergency Department that the lab results were put in and it was her responsibility to review the results and ensure any needed changes to treatment were made. She stated she would either contact the patient directly or direct one of the ED staff to contact the patient.

On 04/25/2019, by reviewing the facility's Emergency Department Control Registry Log and Infection Control ER - Patient Surveillance Form, eight patient medical records who presented to the facility's Emergency Department (ED) during the month of March and April 2019 with possible Urinary Tract Infection (UTI) symptoms were selected for review.

Patient #2 presented to the ED on 04/04/2019 and was diagnosed with a UTI. A urinalysis, to include a C&S, were obtained and sent to the lab and the patient was prescribed Bactrim DS (Sulfamethoxazole and Trimethoprim - a combination of two antibiotics used to treat urinary tract infections) The culture and sensitivity report, dated received on 04/08/2019 (Monday), indicated "Susceptible to penicillin and other beta-lactams. Susceptibility testing not routine performed. Erythromycin and Clindamycin are not recommended for treatment." The C&S report did not indicate that Bactrim DS was a recommended treatment. It was not until Friday, 04/12/2019, that a report was faxed to the patient's primary care physician. There was nothing documented to indicate the report had been reviewed by the ordering provider, the ED physician/nurse practitioner, or that the patient had been notified.

Patient #3 presented to the ED on 03/03/2019 with complaints of urinary issues. A urinalysis, to include a culture & sensitivity (C&S), were obtained and sent to the lab. The patient was prescribed Macrobid 100mg daily. The C&S report, date reported 03/06/2019, identified the presence of "Klebsiella Aerogenes," and was "resistant" to "Nitrofurantoin" (Macrobid). There was no documentation to indicate the final report had been reviewed or that the provider and/or primary care physician had been notified, or that the patient had been notified.

After review of the patient medical records, additional interviews were conducted with the Infection Control Nurse and the Advanced Registered Nurse Practitioner (ARNP), responsible for review of all C&S reports.
On 04/25/2019 at approximately 1:00 PM, a follow-up interview was conducted with the ICN. She was asked about the final C&S reports for Patients #2 and #3. She stated that the results of Patient #2 could be just normal colonized flora in the urine and that the patient may not have needed any antibiotics. She was not able to demonstrate this had been reviewed with the ordering provider. She stated she faxed a copy of the report to the patient's primary care physician, but was not sure of the outcome. There was no documentation to indicate Patient #2 had been notified. The ICN stated that she and the Chief Nursing Officer were just discussing Patient #3 that morning and had emails about changing their process for lab follow-up, as she never got the results of the C&S report.

On 04/25/2019 at approximately 1:30 PM, a follow-up interview was conducted with the ARNP, who was asked if she had reviewed the C&S reports for Patients #2 and #3. She stated she would have to look in the computer, as the only way she would know was if she had put a note in the patient's chart. After review of the records, the ARNP stated she was not sure because there was no documentation. The ARNP stated that she remembered Patient #3 because she received a call from another ARNP with concerns about the patient not having follow-up from them after being prescribed an antibiotic that was resistant to the organism identified on the C&S report.