Failure to Implement Antibiotic Stewardship Protocols
Penalty
Summary
The facility failed to consistently implement its antibiotic stewardship protocols for two residents, leading to the unnecessary administration of antibiotics. For one resident, admitted with dementia and congestive heart failure, the facility's infection tracker form indicated a suspected urinary tract infection (UTI). However, the completed assessment showed that the resident did not meet the McGeer's criteria for initiating antibiotic therapy, as they lacked the necessary symptoms such as fever or acute dysuria. Despite this, a physician's order prescribed Cefdinir, which was administered for seven days, contrary to the facility's antibiotic stewardship policy. Another resident, admitted with type II diabetes, dysphagia, and cerebral infarction, was catheterized to obtain a urine specimen due to an elevated white blood cell count. Despite unremarkable urinalysis results and no clinical signs of infection, the resident received two doses of Rocephin. The facility's Infection Preventionist confirmed the failure to implement antibiotic stewardship protocols, resulting in the initiation and continuation of antibiotic therapy without documented clinical necessity, inconsistent use of infection surveillance tools, and noncompliance with infection prevention and control guidelines.
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 IP and licensed nurses on consistent implementation of the antibiotic stewardship protocols for initiating antibiotic use in accordance with the established infection prevention and control guidelines. To monitor and maintain compliance, the DON / designee will conduct audits of the IP's logs to ensure adherence to the established antibiotic stewardship program including clinical justification for use. The audits will be completed weekly times 4 weeks and then monthly times 3. The results of the audits will be forwarded to the QAPI committee for further review and recommendations.