Unnecessary Antibiotic Administration Due to Non-Adherence to Criteria
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary drugs, specifically antibiotics. Resident #3 was admitted with diagnoses including dementia, dysphagia, and a history of urinary tract infections (UTIs). Despite these conditions, the resident did not exhibit sufficient symptoms to meet the criteria for initiating antibiotic therapy according to McGeer's criteria, which the facility uses to guide treatment decisions for suspected UTIs. The clinical record review revealed that Resident #3 only showed one symptom of dysuria and no additional systemic urinary symptoms. A subsequent evaluation by a certified registered nurse practitioner (CRNP) noted urinary frequency but no other UTI symptoms such as burning, hematuria, fever, or mental status changes. A urine culture showed 50,000-100,000 CFU/mL of Escherichia coli, which did not meet the threshold for diagnosing a UTI. Despite this, the CRNP ordered Cipro, an antibiotic, for five days, which was administered to the resident. The decision to prescribe and administer Cipro was made despite the absence of sufficient clinical indicators for a UTI, as documented in the resident's clinical record. Employee #3, a registered nurse and former Director of Nursing, expressed concerns about the appropriateness of the antibiotic therapy and emphasized the importance of adhering to McGeer's criteria and the facility's antibiotic stewardship program. However, the CRNP confirmed the decision to continue the antibiotic treatment, citing the resident's urinary frequency and positive urine culture as justification, leading to the administration of an unnecessary antibiotic regimen.
Plan Of Correction
Step 1 Resident #3 completed antibiotic course for UTI, appearing to suffer no ill effects prior to survey. Step 2 To identify others with the likelihood to be affected, the DON/designee will complete an audit of the Residents currently ordered antibiotic treatment to ensure McGeer's criteria was followed. Any Residents identified to not meet McGeer's criteria will have documentation evaluated to ensure justification from the Clinician addresses specific reasoning for continued use of antibiotic therapy. Step 3 To prevent a future reoccurrence, the DON/designee will educate all licensed nurses in the facility and Clinicians on McGeer's criteria, to ensure antibiotic initiations meet McGeer's criteria. If the order does not meet McGeer's criteria, the Clinician will be notified, and proper justification will be provided from the Clinician indicating specific reasoning for the same. Step 4 To monitor and maintain ongoing compliance, the DON/designee will audit all new antibiotic initiations to ensure new orders meet McGeer's criteria. If the order does not meet McGeer's criteria, a justification statement will be provided from the Clinician regarding the specific reasoning for continued use of the antibiotic therapy, 3x/week x 4 weeks and then weekly x 8. Results of audits will be forwarded to Facility QAPI committee for further review and provide any necessary recommendations as needed.