Failure in Antibiotic Stewardship Program
Penalty
Summary
The facility failed to maintain an effective system for monitoring antibiotic usage as part of its antibiotic stewardship program. This deficiency was identified during a survey, which revealed that the facility did not adhere to its own policies regarding antibiotic prescribing and monitoring. Specifically, the facility's policy required that antibiotics be prescribed based on clinical indications of active infection or suspected sepsis, and that antibiotic usage and outcomes be documented and reviewed by the infection preventionist. However, the facility did not provide evidence that prescribing practitioners were informed of their prescribing practices, nor did it demonstrate actions to optimize infection treatment through improved antibiotic prescribing and management. The deficiency involved a resident who was admitted with a history of malignant neoplasm of the bladder and dementia. Despite having an elevated white blood cell count, the resident showed no other symptoms justifying antibiotic use. Nevertheless, a physician ordered a urinalysis with culture and sensitivity, and subsequently prescribed Bactrim DS before the culture results were available. The culture later confirmed the presence of an antibiotic-resistant strain of E. coli, rendering the prescribed antibiotic ineffective. The resident received five doses of the unnecessary antibiotic, highlighting a failure in the facility's antibiotic stewardship program. This was confirmed by the Director of Nursing during an interview.
Plan Of Correction
The facility cannot retroactively correct the administration of antibiotic to resident 1. Current residents on antibiotic therapy for a UTI will be reviewed to determine antibiotic necessity and verification of MD notification. Nursing staff and in-house physicians will be re-educated on antibiotic stewardship policy. Audits will be completed on residents who are ordered a UA C&S to determine the necessity of antibiotic and verification of MD notification weekly x 4 weeks, then monthly x 2 months. Findings will be reviewed in monthly QAPI meeting.