HospitalInspections.org

Based on interview, medical record review, and review of facility policy, the facility's laboratory failed to provide adequate laboratory results for the content of the emergency room medical record of 1 of 10 patients reviewed (Patient #1).

Findings:

Interview of Patient #1's mother on 12/04/17 at 11:00 AM revealed that she stated that she took her son to the Pediatrician on 06/15/2017, and the Pediatrician obtained the laboratory result from 06/06/17 of the culture of the wound. She stated that the lab result was from 06/08/17 at 8:17 AM, which the lab test revealed her son had Methicillin Resistant Staphylococcus Aureus (MRSA), and that the hospital had not informed her or her family. She could not understand, if the hospital had a positive result of MRSA on 06/08/17 at 8:17 AM, why her family was not notified when they came to the Emergency Room to recheck Patient #1's wound on 06/08/17 at 3:31 PM.

Interview of the Assistant Nurse Manager, Staff B, on 12/06/17 at 10:45 AM, revealed that she receives a report each morning when she arrives at work for the day shift, of reports from the lab from 1:00 AM that morning titled "Positive Cultures Report." She reviewed the "Positive Cultures Reports" from 06/06 to 06/13/17, which did not reveal a positive culture report for Patient #1. She stated that she reviews these reports to ensure that the patient and provider are aware of the infection results from the culture to identify it, and if not, she reports it to them immediately.

Interview of the Emergency Room Director, Staff A, on 12/06/17 at 11:05 AM, revealed that she reviewed the medical record of Patient #1, and she did not find any content in the medical from the laboratory reporting the positive culture of his wound.

Medical record review revealed that Patient #1 presented to the Emergency Room (ER) on 06/06/17 at 4:09 PM with an infection to his left extremity (leg). A culture was collected from the wound (abscess) on 06/06/17 at 4:28 PM of his left leg to test the infection, and this culture was sent to the hospital laboratory. Patient #1 was administered an intramuscularly injection of an antibiotic by nursing staff, discharged with an order for antibiotics to treat the wound, and with orders for Patient #1 to return in 2 days to the emergency room to recheck the wound. He returned to the ER on 06/08/17 at 3:31 PM to recheck this wound (abscess), and was seen by the Advanced Registered Nurse Practitioner (ARNP) to access his wound. The ARNP documented that the wound was noted to have decreased erythema (redness) and duration, and that it was a resolving abscess. Patient #1 was discharged home with instructions to follow up with his Pediatrician regarding diagnosis, diagnostic test results, and treatment plan. When he returned on 06/16/17 after seeing his pediatrician and receiving the diagnosis of MRSA to his wound to his left leg, he received proper care and antibiotics to treat this infection. Since the laboratory had failed to report to the ER, there was no content in the medical record, hence a delay in the treatment.

Review of the facility Policy and Procedures that was provided by the Emergency Room Director, Staff A, on 12/06/17 at 11:10 AM, revealed the following:
Critical Values and calling and faxing Test Results.
PURPOSE: Florida Hospital Waterman Laboratory is committed to providing accurate results in a timely manner to aid in the diagnosis and treatment of our patients. Under some circumstances it is necessary to call or fax test results to appropriate caregiver upon completion of the test. Criteria have been established to specify conditions in which results must be called to insure quality patient care and safety.
CRITICAL VALUES:
Emergency Department (ED)- The ED provider that is caring for the patient upon identification of any critical test result which is on the list of critical lab values. If the ED provider is unavailable, then the critical test result will be given to the charge nurse or licensed staff member.