Culture (lab test, microbiology) results
Also Consider: Urine Culture, Fever
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Goal is to determine if antibiotic or antiviral therapy is needed, which antibiotic is appropriate, and review the patient’s current clinical status.
1. Take Vital Signs
Temperature:
Blood Pressure:
Heart Rate:
Respiratory Rate:
Oxygen Saturation:
2. Evaluate Symptoms and Signs
Acute mental status change
Not eating or drinking as much as usual
Acute decline in ADL abilities
Signs of dehydration
Respiratory: New cough, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress
Cardiovascular: Chest pain, new irregular pulse, cyanosis, mottling, edema
GI: Nausea, vomiting, diarrhea, constipation, abdominal distention or tenderness, rebound tenderness, bowel sounds
GU: New or worsened incontinence, pain with urination, blood in urine, urinary retention / bladder scan
Neurologic changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)
Skin: sweats (diaphoresis), cold/clammy/pale skin; any new skin condition, i.e., bruising (including potential head trauma), rash, infection/cellulitis
Fingerstick glucose (patients with diabetes)
3. Take Action using SBAR Report:
Presence of other, significant symptoms or signs of illness
Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.
Immediately notify the medical staff & resident representative
Patient appears ill and culture result suggests an appropriate antibiotic is not being given.
Blood Culture: immediately notify for all positive results
Notify medical staff & resident representative within the next 16 hours.
Not on an appropriate antibiotic given the culture result, or positive for a serious virus (COVID-19, influenza).
Notify medical staff on the next business day
Other abnormal culture report.
Notify medical staff at the next regular rounds
All other culture reports
SBAR Report
Situation: "Culture result suggests an appropriate antibiotic is not being given" (and patient appears ill with) (acute symptoms)
Background:
Reason the patient is in the nursing home (rehab for___, long term care for __).
Reason the test was done
Allergies
Culture results
When the problems started, how severe they are, getting worse or staying the same, what treatments have been used.
Abnormal Vital Signs
MOLST / Advance Directives
General observation of patient condition
Similar symptoms in other patient on unit or in facility
Blood glucose, if elevated
Abnormal findings on lung, cardiovascular, abdomen, neurologic or skin observations.
Assessment: I am concerned about: __________
Recommendations/Requests:
Antibiotic if infection is diagnosed
“Hold” parameters for medicines that lower blood pressure
Other:
Clarify expectations for care, interventions, and illness course/prognosis. Repeat any telephone orders back to the provider to ensure that they are correct and complete
4. Implement Management Plan
Monitor vital signs every 4-8 hrs for 2-3 days
Offer fluids frequently
Place on Intake & Output monitoring
Monitor meal acceptance
Place on 24-hour report for 2-3 days
Implement infection control measures if indicated
Update care plan regarding fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs
Review status and plan of care with designated representative with any changes
Update advance directives if appropriate
2025-04-26
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