Failure to Implement Effective Antimicrobial Stewardship Program
Penalty
Summary
The facility failed to establish and implement an effective stewardship program to monitor the use of antimicrobials for two residents. For one resident, a physician ordered a preventative antimicrobial regimen without documented consideration of a 'time out' or pause to reassess the need for continued therapy. The Advanced Practice Registered Nurse (APRN) admitted to not having considered a time out and was unable to provide documentation of the clinical assessment that led to the order, citing issues with transitioning records. The Assistant Director of Nursing (ADON) also could not provide documentation of discussions with providers regarding antimicrobial use. For another resident, antimicrobials were ordered without any diagnostic testing to confirm the need for such treatment. The Director of Nursing (DON) confirmed that no test was ordered and that the provider prescribed the medication without testing. Staff interviews revealed that a physician frequently prescribed antimicrobials based on symptoms alone, such as coughing, without ordering diagnostic tests, and that staff felt unable to discontinue these medications once the provider had spoken to the resident. Review of the facility's stewardship policy indicated that regular review of antimicrobial utilization and laboratory reports was required, but these practices were not followed in the cases reviewed.