Undiagnosed Infections in Nursing Homes
Infections can turn deadly fast, yet many go undiagnosed in nursing homes until it’s too late. In this episode, nursing home abuse lawyer Rob Schenk talks with guest Theresa Laxton about why infections are often missed, the signs families should watch for, and how early detection can save lives.
Laxton:
It could be sepsis, it could be just an infection that becomes resistant to antibiotics. It could be for a variety of reasons, but they can get very sick very quickly from something that you and I would not think twice about. And that’s why it’s important to identify them early, treat them efficiently, and really identify the signs. Is the key to that?
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking about. The problem of undiagnosed infections. Like what, what happens between the time that I guess the germs become prevalent enough in the body that they cause an infection to the time that it takes for the nursing home to recognize that there is an infection, like what’s going on in that that middle period?
But we’re not having that conversation alone. We have the fantastic Theresa Laxton. On the program to walk us through that process. As I mentioned before, all about.
Undiagnosed infections, what that means, what it entails for the health of the resident, but we’re not doing that alone. We have Theresa Laxton on to talk to us today. Theresa is a certified legal nurse, consultant and owner of Laxton Consulting LLC. With 24 years of nursing experience in emergency medicine, trauma, long-term care and compliance, she offers valuable insights into medical legal cases.
Theresa assists attorneys by analyzing records and identifying deviations from the standard of care. Outside of work. She enjoys traveling, ballroom dancing, cooking, hosting, game nights, and spending time. With the fam. We’re so lucky to have her on the show today. Theresa, welcome to the show.
Laxton:
Thank you for having me, Rob.
What are undiagnosed infections and why is it crucial to recognize infections in nursing homes?
Schenk:
So here’s a softball question right outta the gate, and I guess this is gonna frame how we talk for the next few minutes, but what is an undiagnosed infection?
Laxton:
An undiagnosed infection is essentially an infection that a patient has that. Hasn’t been identified, therefore not given an opportunity to be addressed and treated.
This article discusses antibiotic use and resistance concerns in elder care on the impact of preventive health measures in elderly populations.
What are common causes of undiagnosed infections?
Schenk:
And what are some of the more common infections in nursing homes that go undiagnosed, for a longer amount of time?
Laxton:
Some common ones would be probably our biggest offender would be urinary tract infection or UTI. There can also be wound infections that kind of hide in places that are easily missed when they’re.
Are getting for even upper respiratory infections. We think, gosh, we would know when we have a cold. But sometimes folks they can’t tell us when they have a stuffy nose or feeling that cough. And then, or an ominous one that can go undiagnosed and can be dangerous would be sepsis.
A foundational study on infection prevalence in nursing homes highlights risk factors on the impact of preventive health measures in elderly populations.
What are typical signs and symptoms of infections that can go unnoticed?
Schenk:
What would be the reason why? You would have an infection from. I guess at some point we have identified that there’s enough germs that we call it an infection to where it’s diagnosed. Like why does it, why might it take longer than normal to diagnose an infection?
Laxton:
Because a lot of times for folks who are in a nursing home.
They can have infections that might present or that would be noticed differently than you and I would have it. For example, a urinary tract infection can really be a hidden culprit in folks in nursing homes. Typically the reason it might not go. Diagnosed for very long is because the symptoms present differently in those folks.
Sometimes they can have changes in their behavior, changes in their level of consciousness versus maybe those typical symptoms of a urinary tract infection that somebody of a different age might have. The other thing too is if they have dementia. They might not be able to tell us what’s causing them problems.
Learn how multidrug-resistant organisms are impacting long-term care on the impact of preventive health measures in elderly populations.
They might not be able to say what’s bothering them or what’s hurting them. The other thing too is if they’ve got other things going on or what we would call comorbidities, other health issues that might even disguise an acute infection, which means something that came on recently and, the other thing too is if there’s a lot of different caregivers that come and go they might not notice that patient’s different or something’s different about their body or their mentation that might indicate an infection.
Review this analysis of the CDC guidelines for antimicrobial use in long-term care settings on the impact of preventive health measures in elderly populations.
Who should recognize these signs and symptoms?
Schenk:
That’s an interesting point. When you have a resident at a nursing home, who would be the responsible party for identifying those signs? If someone’s baseline is X and now they’re not X, who’s, who would be the person that needs to point that out or needs to notice that?
Laxton:
Anybody can within the nursing home setting many of them, they have the same people that see them all the time, every, everyone from the CNA that gets them up and gets them dressed for breakfast to the dietary aid that gives them their breakfast to the activities director that helps them participate in whatever’s going on in activities to the administrator who rounds on the patients.
Discover how to reduce urinary tract infections in Preventing Catheter-Associated UTIs: What to Know.
So really anybody who knows that patient can say. Gosh, Mr. Smith is just connecting himself today. And that’s different than it was earlier this week. I wonder if something’s going on. Maybe we should look a little closer at this. So it can go beyond the caregivers or the providers or the nurse practitioner. Really anybody that knows ’em can say, gosh, something’s different. Let’s take a look.
Explore the biological aging factors that contribute to infection risk in the elderly on the impact of preventive health measures in elderly populations.
Schenk:
In residents that have some type of cognitive impairment where, as you mentioned before, like they can’t just tell us like, oh, I have pain when I go pee. And so they are now presenting different symptoms to, to the nursing home.
How does the nurse or whoever the caregiver is, how do they go from this person is not acting like themselves to, oh, let’s check for this type of infection versus this type of infection versus this type of infection.
Laxton:
Good question. With that patient. A lot of times those folks who know them would know when something’s going on and would know what their baseline should be.
And from there they should look at what was different. Was there something in the environment that was different that would indicate maybe just environmental changes that are lending it to that? Was there a different medication? Was there something new, a new treatment? Did they act differently? Were they wetting their clothes when they weren’t before maybe they started to become incontinent.
If your family member passed away from an infection, read about sepsis-related nursing home claims.
So once they’ve identified that something’s different, why and what could it be attributed to? And you go on that method of elimination. And then. It gets to that point, they would call their provider, their nurse practitioner, the physician, and Hey, I think something’s different. Maybe we should investigate further.
And that could be urine sample, that could be lab work that could be checking vital signs. I don’t know the last time they took them, what were their vital signs here to here? What was their temperature? What was their weight? Are they losing weight? Are they not eating? And then they would alert their provider.
Recurrent infections may be a red flag—learn how to spot nursing home neglect from frequent UTIs.
That’s really the point that it becomes that frontline caregiver, that nurse, the CNA, the QMA is really important to alerting. The person who gives the orders, again, nurse practitioner, physician, whoever it may be. Start the process of elimination from that point.
Stay updated on current nursing home protections by reviewing coronavirus-related laws for long-term care facilities.
How are infections treated in the nursing home? What can be treated on site and what should go to the hospital?
Schenk:
Is it the case that typically, once the nursing home has, once the nursing staff has identified that there’s possibly an infection and they contact the attending physician is it normal for the attending physician to say, okay, let’s do this lab, or let’s do a urine sample or whatever it is. Or is it something else? Do you send them out, like typically is it. Just let’s run some, let’s run some tests.
Laxton:
That’s a real tricky question. It really depends on the provider. A lot of times when those providers, whether it be nurse practitioner or attending physician, works a lot with the same nurses.
They trust their assessment. If the nurse says, gosh, let’s start out with checking some labs or things like that, what do you think? They’ll start from there. But if it’s maybe a provider at the nursing home that doesn’t know them well, maybe it’s an agency staff person and they call the attending who maybe is not familiar with the patient, it’s much more likely that they would send them out because they don’t know what their baseline is.
Before selecting a facility, be sure to always check nursing home ratings.
And that process of elimination might not be as efficient because they don’t really know where to start. So they say send them out to err on the side of caution and let the hospital look from. Look for infections or whatever it may be from there.
In Episode 27: Common Infections Found in Nursing Home Residents, we explore the most frequent clinical issues in elder care.
What happens if an infection goes undiagnosed and untreated?
Schenk:
What happens typically when. Everybody drops the ball and an infection goes untreated. What kind of, what happens in the body?
Laxton:
Sometimes those smallest infections can really lead to big problems. And we had mentioned that insidious sepsis earlier. Sepsis is when there’s really a. Essentially an overwhelming response to infection in the body. And it can precipitate the, any infection can precipitate that in, in that really compromised elderly population.
They can get very sick very quickly and it really doesn’t take much. And something like sep which could be an untreated infection. Organ breakdown and really can make it difficult for them to get on the other side of, so it could be sepsis, it could be just an infection that becomes resistant to antibiotics. It could be a variety of reasons, but they can get very sick very quickly from something that you and I would. Think twice about, and that’s why it’s important to identify them early, treat them efficiently and really identify the signs. Is the key to that.
Episode 98: Are Nursing Homes Liable for Infections? breaks down when liability attaches.
How can documentation indicate an infection or problem?
Schenk:
How important would you say documentation is?
You mentioned taking vitals, you mentioned documenting that maybe someone has now become incontinent. Like how important is it that those things get taken down in the chart?
Laxton:
Imperative documentation, paints the picture and gives the story of what has happened over days, weeks, months, sometimes years for somebody who doesn’t know that patient to come in and look at where they were, what happened and where they are now.
So say for example, there’s a new medical director that comes in to see the patients in the nursing home. How would they know what happened before? Unless there’s good documentation. I know that seems really elementary. It seems very yes, of course we would do that. But documentation extends to Yes.
Learn how improper response to infection can turn fatal in Nursing Home Sepsis and Septic Shock.
Are they normally continent? What are their vital signs? What are their normal weights? What is their normal level of consciousness? Baseline? I think that this is a huge piece for residents in a nursing home that because that’s a lot of times the first indication that something’s wrong is level of consciousness change.
So what is their baseline? And I think when residents get treated by a new provider, when residents go to the emergency department or get picked up by an ambulance communicating. What is different? What is their baseline level of consciousness? If they’re not answering my questions, but that’s normal for them. Okay. But if they’re not answering my questions and two days ago they were playing bingo and ambulatory and could. Recite all kinds of things to you, that’s a big change and a relatively big change. That’s important. Documentation for when they go to the hospital so that they can look back at the records and see how were they treated.
Episode 143: Infection Control in Nursing Homes discusses preventive protocols and failures.
Were labs done when we first noticed something and what were they? Is there a change now? Was their weight? Are they losing weight? Gaining weight? ’cause that’s an important piece of assessment information. And also what are their medications and what response did they have to them. If they did not have a favorable response to a medication, then when they go to the hospital and somebody doesn’t know them, they should look back and say, oh, this didn’t work. Or there were side effects that we didn’t want from it. We know not to do that again, and particularly because they might not know to tell us. Which is why all the more important that documenting in their medical record is advocating for them when they can’t speak for themselves as well.
Episode 79: How to Prevent Sepsis in Georgia Nursing Homes offers practical safety guidance.
Schenk:
Very well said. Well, Theresa, thank you so much for coming on the show today to share your knowledge with us.
Laxton:
It’s been a pleasure, Rob. Thanks for having me,
Schenk:
Folks. I hope that you found this episode educational. A quick aside, what I think is funny is that every week we, when we reach out to potential guests, we always ask how do we pronounce the name?
Because sometimes like you don’t know, like you don’t know how somebody’s name is pronounced. And Theresa was like my name is pronounced like Mother Theresa. And I’m like, I’m scratching my head because I feel like I’d as a southern guy. It’s Theresa, like there’s no question, but I feel like I hear like on the YouTubes and documentaries and stuff, it’s Theresa Mother, Theresa.
Maybe that’s like how the English people say it. I don’t know, but it did. I did have to actually clarify her clarification to make sure that I was saying it to Theresa, not Theresa. Anyway, I digress. If you have an idea for a topic that you want me to talk about, please let me know. If you have an idea for someone you want me to talk to, like Theresa, let me know that as well.
New episodes of Nursing Abuse Podcast come out every single Monday. And please for the love of all things, who, speaking of Mother Theresa, enter to win this mug. There’s a hundred of these mugs in boxes in my house, and my wife is not letting me forget that. Please take one off my hands. And with that folks. We’ll see you next time.
Theresa Laxton’s Contact Information: