Failure to Monitor Long-Term Antibiotic Use per Stewardship Policy
Penalty
Summary
The facility failed to implement its Antibiotic Stewardship policy and procedures by not evaluating and monitoring the ongoing use of a long-term antibiotic for one of twenty sampled residents. Specifically, a resident with a history of metabolic encephalopathy was prescribed Rifaximin for encephalopathy, but there was no evidence of monthly medication regimen reviews (MRR) for this antibiotic from January to March. The Infection Control Prevention Nurse (ICPN) did not include this resident in the antibiotic tracking log, as the log was limited to residents with infections, despite the resident's ongoing use of an antibiotic. The ICPN acknowledged that routine monitoring for medication use and appropriateness should have been conducted monthly, and that there was no documentation of side effect monitoring or a stop date for the medication in the clinical chart. Interviews with the ICPN and the Director of Nursing (DON) confirmed that the expectation was for all antibiotics, both short-term and long-term, to be tracked and reviewed for indication of use, and to be included in the care plan. The DON stated that the ICPN should have followed up with the MRR and pharmacy recommendations regarding antibiotic appropriateness and continued use on a monthly basis. The facility's policy on antibiotic stewardship, revised in May 2001, indicated that the purpose of the program was to monitor the use of antibiotics in residents, which was not followed in this case.