Failure to Implement Antibiotic Stewardship Program and Monitor Antibiotic Use
Penalty
Summary
The facility failed to implement its antibiotic stewardship program for two residents, resulting in deficiencies related to the monitoring and documentation of antibiotic use. For one resident with a history of acute cystitis, peritoneal abscess, and bacteremia, there was no documented indication for the use of Bactrim, and an antibiotic time-out was not performed after the medication was started. The Infection Preventionist Nurse (IPN) was unable to determine the reason for the Bactrim prescription and found no supporting documentation in the physician or surgeon's notes. Additionally, there was no laboratory testing conducted to justify the initiation of Bactrim, and the medication order lacked an end date, contrary to facility policy and standard practice. For another resident with multiple myeloma and anemia, Bactrim was prescribed for prophylactic use without a care plan or documentation of monitoring for adverse reactions or side effects. The IPN acknowledged that the antibiotic time-out was completed only once, with no subsequent laboratory evaluation or assessment of the resident's status. Nursing progress notes did not include any information about monitoring for side effects or adverse reactions, and the resident's care plan did not address the ongoing use of Bactrim. Facility policy requires that all antibiotic prescriptions specify dose, duration, and indication, and that nursing staff conduct antibiotic time-outs within 48-72 hours of starting therapy. The policy also mandates monitoring for response to antibiotics and documentation of assessments. In both cases, these protocols were not followed, as evidenced by missing documentation, lack of laboratory testing, and absence of care planning and monitoring for adverse effects.