Failure to Implement Antibiotic Stewardship and UTI Criteria
Penalty
Summary
The facility failed to implement its antibiotic stewardship program as required by its own policy and the McGreer Criteria for infection surveillance. Specifically, the facility did not ensure that symptoms met the criteria for urinary tract infection (UTI) and did not consistently obtain or review urine cultures before initiating antibiotic treatment for four out of six residents reviewed for antibiotic stewardship. The policy required tracking antibiotic use daily and using the McGreer Criteria to guide UTI diagnosis and treatment, including documentation of symptoms and microbiological evidence. For several residents, antibiotics were prescribed and administered without adequate documentation of symptoms or urine culture results. One resident was treated with Ciprofloxacin for UTI symptoms, but no urine culture was obtained, and there was no documentation of a McGreer form. Another resident received two courses of antibiotics for UTI, but there were no recorded symptoms for one course, and the urine culture showed mixed flora without a repeat culture. A third resident was treated with Nitrofurantoin despite a urine culture indicating resistance to this antibiotic, and there was no evidence that the culture results were reviewed or that follow-up with a physician occurred. In another case, a resident received antibiotics for UTI, but the urine culture was only obtained later and not reviewed during treatment. Interviews with facility staff confirmed that infection control logs did not consistently document symptoms or urine cultures for the affected residents. The Infection Preventionist and Director of Nursing acknowledged that required documentation, including completion of the McGreer form and review of culture results, was missing in several cases. The staff also confirmed that antibiotics were sometimes started based on family requests or preliminary urine dipstick results, without following the full protocol for confirming UTI diagnosis and appropriate antibiotic use.