Failure to Follow Antibiotic Stewardship Protocols for Influenza Case
Penalty
Summary
The facility failed to ensure that a resident met the appropriate criteria for antibiotic treatment as part of its antibiotic stewardship program. A resident with a history of obesity, diabetes, heart disease, and overactive bladder was admitted and later developed respiratory symptoms, including cough and slight dizziness. Diagnostic studies were ordered, and the resident tested positive for Influenza A. Despite this, the resident was prescribed doxycycline, an antibiotic, and prednisone, a steroid, for treatment of Influenza A, and received these medications for several days. Medical record review showed that the resident did not meet the McGeer criteria for antibiotic treatment of influenza, as the required combination of symptoms was not documented. The resident had a fever and cough, but there was no evidence of at least three additional symptoms such as chills, headache, myalgias, malaise, or sore throat, as required by the criteria. Additionally, although a chest x-ray was ordered to rule out pneumonia, there was no evidence in the records that this diagnostic test was completed. The infection control log indicated that the resident met criteria for antibiotic treatment, but this was not supported by the documented clinical findings or by CDC guidelines, which state that influenza should not be treated with antibiotics. The facility's own policy required the use of McGeer and Loeb criteria to determine the necessity of antibiotics, and prescriptions were to be reassessed for appropriateness based on diagnostic results and clinical status. These protocols were not followed in this case, resulting in the inappropriate use of antibiotics.
Plan Of Correction
The facility will continue to ensure criteria for antibiotic use is being met. Resident #238 continues to reside at the facility. The resident has completed antibiotic treatment with no adverse effects. An initial audit of the last 30 days of antibiotic (ATB) use was conducted by the DON and infection preventionist on 4/17/2025. No negative findings were noted. On 4/14/2025, the Regional Clinician met with the Senior DON, Facility DON (infection preventionist), and Nurse Managers to review current policies and procedures for ATB stewardship. By 4/17/2025, the licensed nursing staff will be reeducated on ATB stewardship, criteria for antibiotic use, and clarifying antibiotic orders when they don't meet criteria, ensuring the rationale is documented in the medical record. Weekly, for 2 weeks or as directed by the QA committee, the DON and/or designee will audit 3 residents on ATB to ensure symptom criteria are met to treat with antibiotics. Negative findings will be reported to the QA committee, and the prescriber will be notified for clarification and rationale for treatment if continuing ATB. The Administrator will ensure the completion of the weekly audits. The DON is responsible for ongoing compliance.