IDPH has cited and fined Hillside Rehabilitation and Care Center in Yorkville after the nursing home failed to obtain lab tests for a resident who was taking blood thinner medication.
Many nursing home residents take anticoagulant or “blood thinner” medications. Used for a variety of purposes such as a history of blood clots, atrial fibrillation, stroke prevention, and management of other circulatory and cardiac conditions, this class of medication can be crucial for maintaining the health and well-being of the resident for whom the medication was ordered.
However, the use of this medication has to be carefully managed. If the blood is considered “too thick,” or subtherapeutic, it can lead to blood clots which can have catastrophic consequences; if the blood is “too thin,” or supratherapeutic, this can lead to uncontrolled bleeding.
To ensure that the resident remains in the desired or therapeutic range, the resident must receive regular blood testing called a PT/INR test which is measures whether the blood is in the therapeutic range. If the blood is outside the therapeutic range, then the nurse must contact the doctor to notify him that the resident had an abnormal lab result. From there, it would be up to the doctor to make adjustments in the dosing of the blood thinner medication or to take other steps to treat the condition.
The resident at issue had a history of blood clots and had peripheral vascular disease (poor circulation to the extremities) and was receiving blood thinner medications to treat this. As part of his treatment regimen, there was also an order in place for regular blood draws for PT/INR testing.
When lab work is ordered for nursing home residents, this is performed by an outside laboratory who will send a technician to the nursing home to do the blood draw and then take the sample back to the lab to have the test done. Results will then be forwarded to the nursing home who in turn will notify the doctor of any abnormal results.
Here, the nursing home had a contract with a single lab to perform the testing. However, the technician did not show up to perform the testing, so no test was performed. The following day the resident was sent to the hospital suffering from a brain bleed. In the emergency room a PT/INR test was performed. The result was a score of 7.5 when the normal range is 0.8-3.5. The conclusion at the hospital was that the brain bleed was due to supratherapeutic INR. In other words, the resident’s blood was too thin, leading to the brain bleed. Had the ordered lab work been performed, the doctor could have acted on the elevated INR and prevented the brain bleed from occurring.
There are a number of issues with the care that this resident received. First, the lab that had contracted with the nursing home did not provide the services that were required, raising questions of its liability for failing to provide the ordered testing. Second, the nursing home staff was aware that over the past few months leading up to this incident, the quality of the lab’s performance had dropped and that there had been problems getting ordered tests performed. However, nursing home management had a contract with a single lab and did not have options available for the staff to look elsewhere for testing. Third, the nursing home staff failed to notify the doctor that the tests he ordered had not been done. All of these issues led to a very preventable injury to this nursing home resident.
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