Failure to Ensure Appropriate Antibiotic Prescribing for UTI
Penalty
Summary
The facility failed to ensure appropriate prescribing of antibiotics for one resident with a urinary catheter who was reviewed for urinary tract infections (UTIs). The resident was prescribed Bactrim DS for a UTI without documented clinical symptoms to support the diagnosis, and antibiotics were initiated before obtaining urine culture results. The infection control log indicated that criteria were not met for clinical documentation to support antibiotic use, and the urinalysis showed mixed flora, with a recommendation to repeat the specimen collection. Despite this, no repeat culture was obtained prior to the resident's hospitalization, and a sensitivity report was not completed to guide antibiotic selection. Nursing notes documented the resident was on isolation for MRSA and had a catheter-associated UTI, but there was no documentation of symptoms prompting the urinalysis or antibiotic treatment. The Quality Assurance Nurse/Infection Preventionist confirmed that the resident did not have documented symptoms of UTI prior to the antibiotics being ordered and that a repeat culture should have been performed. The Advanced Practice Registered Nurse also stated that antibiotics for UTIs should not be started until after urine culture results are received, which was not followed in this case.