Failure to Use McGeers Criteria Before Initiating Topical Antibiotic
Penalty
Summary
The facility failed to ensure that McGeers criteria were used to assess a resident prior to the initiation of a topical antibiotic for a left big toe infection. The resident, who had diagnoses including type 2 diabetes mellitus, dementia, and depression, was admitted with moderate cognitive impairment and required substantial assistance with activities of daily living. Medical documentation showed that a physician assistant ordered bacitracin ointment to be applied to the resident's left big toe for a skin infection, and this order was carried out as documented in the Treatment Administration Record. Interviews with the Infection Preventionist and the Director of Nurses confirmed that McGeers criteria, which are required by facility policy to define infections and guide antibiotic use, were not utilized before starting the antibiotic treatment. The facility's policy on antibiotic stewardship specifies that nursing staff should assess residents using McGeers criteria prior to notifying the physician and that antibiotic orders should be reviewed for appropriateness. Despite these protocols, the required assessment was not performed in this case.