The IDPH has issued a citation to Arcadia Care Danville following the death of one of its residents due to an improperly treated urinary tract infection (UTI). This is a case where two very basic yet critical responsibilities of a nursing home failed: the duty to be in touch with the doctor, and the duty to administer medication correctly.
Tragic Battle with Infection at Nursing Home
The resident’s complicated medical history included frequent urinary tract infections, to the point where some of the bacteria causing the infections became resistant. Because the usual antibiotics were no longer working, the patient needed additional testing to confirm the best course of treatment.
During one bout of UTI, the resident got the doctor’s order to take an antibiotic called Levaquin, and also to get a urinalysis with a “culture and sensitivity” test. This test was to determine exactly what kind of bacteria was causing the infection, and what drugs the organism would be susceptible to. The doctor wanted the culture and sensitivity test to see whether the Levaquin was working and whether he needed to adjust the treatment for the resident.
The resident’s test result revealed that the bacteria was resistant to Levaquin, and therefore the course of treatment needed adjusting. His doctor was never notified of the irregular lab result.
Patient’s Doctor was Not Notified About Abnormal Lab Results
Nursing homes are not required to have a physician on site 24/7, but they are responsible for communicating with the doctor when there is a medical irregularity in any of the residents. The doctor would then either come to the nursing home to personally examine the situation, issue orders by phone, or have the resident sent to the hospital.
In this case, the doctor was not notified of the abnormal lab result. Without the physician adjusting the treatment plan, the resident continued to take the medication that wasn’t effective against the UTI.
In the days that followed, the nursing home staff noted the resident’s changes in mental status, abnormal urine appearance, and possible seizure activity. These were all signs of a worsening infection. In addition, another set of labs showed that the resident had elevated creatinine and Blood Urea Nitrogen (BUN) levels, both of which indicated dehydration associated with UTI. His ammonia levels were also elevated — another abnormal finding that needed to be addressed.
Again, this was a situation that should have been communicated to the doctor, but no notification was made.
On top of these, lab tests could not detect the resident’s potassium levels. Potassium is a nutrient that drops to low levels during UTI, so the resident had to be on a potassium supplement to keep this nutrient in his body. Sadly, this supplement was missed when he was transferred from the nursing home into hospice. During the transfer, the hospice staff never received from the nursing home the full list of medications that he was supposed to take.
The resident suffered more symptoms of worsening infection, including increased lethargy, fever, and changes in mental status. Two and a half weeks after his initial abnormal urinalysis, the resident tragically passed away.
The cause of death was sepsis from the improperly treated urinary tract infection, combined with dehydration and loss of potassium.
Preventable Resident Death, Lapses in Care
The doctor told the state surveyor that these two things — the failure to notify a physician and the medication error — contributed to the resident’s death.
Though these are basic responsibilities of a nursing home, these lapses are all too common among these facilities. We have seen numerous cases of resident injuries and deaths resulting from the staff’s lack of communication with the doctor, lack of vigilance to spot irregularities, and irresponsible handling of treatments. Such injuries and deaths would have been prevented had those nursing homes fulfilled their duties correctly.
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