Failure to Ensure Antibiotic Use Met Established Criteria
Penalty
Summary
The facility failed to ensure that antibiotic usage met established criteria, as evidenced by the administration of antibiotics to four residents without proper documentation or justification according to McGeer's criteria. In one case, a resident with chronic respiratory failure, heart failure, and liver disease was given Omnicef for pneumonia despite not meeting the criteria for antibiotic treatment, with no documented explanation from the physician. The infection preventionist confirmed that the x-ray did not show pneumonia and there was no evidence supporting the need for antibiotics. Another resident with heart failure, diabetes, and benign prostatic hyperplasia received Bactrim for a urinary tract infection after returning from the hospital, but was not listed on the infection control log and did not have McGeer criteria completed. The DON and RN confirmed that the resident did not meet the criteria for antibiotic treatment, and the infection preventionist was not notified until several days after the antibiotics were started. Similarly, a resident with dementia and diabetes was started on Keflex for a suspected urinary tract infection without a completed culture or McGeer criteria form, and there was no evidence that the physician was informed about the lack of culture results. A fourth resident with dementia, ileus, and dysphagia was treated with Keflex for a urinary tract infection after returning from the emergency room, despite a urinalysis showing no significant growth and not meeting McGeer's criteria. The DON documented that the resident was started on antibiotics in the emergency room, but the medical provider ordered the medication to be continued based on a change in condition, agitation, and increased confusion, rather than established infection criteria. Facility policy required the infection preventionist to ensure appropriate testing and documentation before antibiotics were ordered, but this was not consistently followed.