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 assessment of antibiotic use. For one resident with pneumonia, diabetes, and dementia, Zosyn was administered intravenously following transfer from a hospital. Documentation revealed that the indication for use and infection surveillance assessment were not completed as required. The Infection Preventionist (IPN) admitted to not performing the necessary infection surveillance or reassessment (antibiotic time-out) to determine if the antibiotic was still indicated, and was unsure if the use met McGeer's Criteria. The Director of Nursing (DON) later confirmed that the criteria were not met, but the antibiotic course had already been completed without proper assessment or documentation. For another resident with a history of asthma, hypertension, atrial fibrillation, and hyperlipidemia, daptomycin was ordered and administered intravenously for a right hip wound MRSA infection. While an initial infection surveillance assessment was completed at the start of therapy, the resident was not included in the antibiotic stewardship binder, which tracks residents on antibiotics. No subsequent monitoring or reassessment was performed to determine the ongoing need or effectiveness of the antibiotic. Both the IPN and DON acknowledged that there was no follow-up or ongoing monitoring for this resident while on the antibiotic, and the resident was not tracked as required by facility policy. The facility's own policy and procedure for antibiotic stewardship requires that all antibiotic use be monitored, assessed for indication, dose, and duration, and that ongoing surveillance and reassessment (antibiotic time-out) be performed. The policy also mandates that all residents on antibiotics be tracked and reviewed for appropriate use. In both cases, these procedures were not followed, resulting in a failure to ensure appropriate and necessary use of antibiotics for the affected residents.