This federal F-Tag regulation (§483.50(a)(2)) requires nursing facilities to obtain laboratory services only upon a valid order from an authorized practitioner (physician, PA, NP, or CNS) and to promptly notify the ordering practitioner of any laboratory results falling outside clinical reference ranges, per facility policies and medical orders. Facilities must develop policies—in consultation with the medical director—defining out-of-range categories, reporting urgency, and communication monitoring. Surveyors will cite deficient practice if labs are ordered without proper authorization or if abnormal results are not communicated promptly.
View official sourceF773 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.50(a)(2) The facility must— (i) Provide or obtain laboratory services only when ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws. (ii) Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside of clinical reference ranges in accordance with facility policies and procedures for notification of a practitioner or per the ordering physician’s orders. GUIDANCE §483.50(a)(2)(i)(ii) For purposes of this requirement “promptly” means that results shall be relayed with little or no delay to the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist according to facility policies and procedures for notification and the medical orders. Facility policies and procedures should be developed in consultation with the medical director and follow current standards of practice. Such policies may include defining categories that are considered outside clinical reference ranges for laboratory values, the urgency of reporting values, and a process for monitoring the effectiveness of communication to ensure that communication was received, and delegation by the ordering provider to a qualified on-call individual as appropriate. PROCEDURES When reviewing the resident’s medical record, surveyors would determine that laboratory services were provided only when ordered by a physician, physician assistant, nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws, and facility staff and the ordering provider(s) were promptly notified of the results. If test results were not acted upon in a timely manner by the physician, physician assistant, nurse practitioner, clinical nurse specialist, or by facility staff as ordered, consider additional review for possible deficient practices under Medical Director, Nursing Services, Quality of Care or Quality of Life requirements. Do not cite any related or associated requirements before first conducting an investigation to determine compliance or non-compliance with the related or associated requirement. KEY ELEMENTS OF NONCOMPLIANCE To cite deficient practice at F773, the surveyor’s investigation will generally show that the facility failed to do any one or more of the following: • Obtain or provide laboratory services without an order by a physician, physician assistant. nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws; OR • Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results according to facility policies and procedures for notification and the medical orders.