Failure to Implement Antibiotic Stewardship Protocol for UTI Treatment
Penalty
Summary
The facility failed to implement its protocol for Antibiotic Stewardship by not ensuring that antibiotics were only administered when the established criteria, specifically the McGeer criteria, were met. For two sampled residents, antibiotics were given for urinary tract infections (UTIs) without documented evidence that both required clinical and microbiological criteria were satisfied. In both cases, the residents received antibiotics based on positive urine cultures, but there was no documentation of the necessary clinical symptoms as outlined in the McGeer criteria. One resident, with a history of cerebral infarction, epilepsy, and paraplegia, was prescribed and administered Keflex via gastrostomy tube for a UTI. The medical record showed a positive urine culture for Escherichia coli, but there was no evidence that the resident exhibited the required clinical signs or symptoms for UTI treatment per the McGeer criteria. Nursing staff confirmed that the antibiotic stewardship process was not completed and acknowledged that the resident did not meet the criteria for antibiotic therapy. Another resident, diagnosed with atherosclerotic heart disease, hyperlipidemia, and dementia, was prescribed Bactrim DS for a UTI following a positive urine culture for Klebsiella pneumoniae. The resident's care plan included monitoring for UTI symptoms, but there was no documentation that the resident met both the clinical and microbiological criteria for antibiotic use. Nursing staff confirmed that the antibiotic stewardship protocol was not followed, and the required Nurse to Physician Report was not completed prior to administering the antibiotic.