Unnecessary Antibiotic Administration
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary antibiotics. A resident, admitted with a history of malignant neoplasm of the bladder and dementia, had an elevated white blood count but no other signs of infection. Despite this, the physician ordered a urinalysis with culture and sensitivity to assess for possible infection. The resident was catheterized to obtain a urine sample, and the results were pending. However, before the culture and sensitivity results were available, the physician prescribed Bactrim DS, an antibiotic, to be administered every 12 hours for five days. The laboratory report later revealed that the urine culture identified Escherichia coli ESBL, which was resistant to the prescribed antibiotic, rendering the treatment ineffective. The resident received five doses of Bactrim DS before the culture and sensitivity results confirmed the medication's ineffectiveness. During an interview, the Director of Nursing confirmed that the administration of Bactrim DS was not clinically justified, as it was ineffective against the identified organism, resulting in the resident receiving an unnecessary medication.
Plan Of Correction
The facility cannot retroactively correct the ordered administration of the antibiotic to resident 1. Lab culture results will be reviewed on all current residents receiving antibiotic therapy for a UTI to ensure that the ordered antibiotic is clinically justified. Nursing staff will be re-educated on medication necessity related to evidence-based infection control and antimicrobial stewardship practices. Audits will be completed on new antibiotics for UTIs to determine the necessity weekly x 4 weeks, then monthly x 2 months. Results will be reviewed at the monthly QAPI meeting.