Failure to Ensure Drug Regimen Free from Unnecessary Antibiotics
Penalty
Summary
The facility failed to ensure that the drug regimens for two residents were free from unnecessary medications, specifically antibiotics, as required by §483.45(d). Resident 34 was administered Cefdinir for a suspected urinary tract infection (UTI) despite lacking essential clinical indicators such as fever, dysuria, leukocytosis, or gross hematuria. The only criterion met was a urine culture with >100,000 CFU/mL of a single organism, which alone was insufficient to justify antibiotic therapy. This resulted in the resident receiving fourteen doses of an unnecessary antibiotic. Resident 71 was prescribed Rocephin, an antibiotic, without meeting McGeer's Criteria or having laboratory evidence of an infection. The resident's urinalysis results were unremarkable, and the urine culture showed no growth, although the white blood cell count was elevated. Despite this, Rocephin was administered for two days. The facility's Director of Nursing confirmed that the required "Infection Tracker form with McGeer's Criteria - 2024" was not completed to clinically justify the use of the antibiotic. The facility's Infection Preventionist and Director of Nursing confirmed the deficiencies in antibiotic prescribing practices. The Infection Preventionist acknowledged that Resident 34 did not meet the requirements for antibiotic treatment, while the Director of Nursing reported that the prescribing physician for Resident 71 was aware that the signs and symptoms did not meet McGeer's protocol for prescribing an antibiotic. These failures indicate a lack of adherence to the facility's antibiotic stewardship program and resulted in the administration of unnecessary medications.
Plan Of Correction
The facility is unable to correct the findings identified for R34 and R71. To identify other residents that have the potential to be affected, the IP / designee will audit the past 2 weeks for antibiotics that were ordered to determine if the McGeer's criteria had been completed to clinically justify the use of the antibiotic. Follow up will occur based on the audit findings. To prevent this from reoccurring, the DON/ designee will educate the licensed nurses and providers related to providing documented evidence of clinical necessity for administration of antibiotics and unnecessary medication prescribing practices. To monitor and maintain compliance, the IP / designee will complete audits during the clinical morning meetings for residents with antibiotics ordered to verify there is documented evidence of clinical necessity for ordering the antibiotic. The audits will be completed 5 days per week times 4 weeks and then weekly times 4. The results of the audits will be forwarded to QAPI committee for further review and recommendations.