Failure to Monitor and Include Antibiotic Use in ASP Surveillance
Penalty
Summary
The facility failed to implement its Antibiotic Stewardship Program (ASP) for one resident by not monitoring and including the resident's use of methenamine hippurate, an antibiotic, in the ASP infection surveillance data. The resident in question was admitted with diagnoses including urinary tract infection, extended spectrum beta lactamase (ESBL) resistance, resistance to multiple antibiotics, and overactive bladder. The resident was dependent on staff for activities of daily living and was prescribed methenamine hippurate for UTI prophylaxis, but this medication was not tracked in the facility's ASP surveillance report. During interviews and record reviews, the Infection Preventionist (IP) confirmed that all antibiotics, including those used for prophylaxis, should be ordered with a stop date, monitored for effectiveness and side effects, and included in the ASP surveillance data. The IP acknowledged that the order for methenamine hippurate did not include a stop date and that the resident's use of this antibiotic was overlooked and not included in the monthly ASP report, contrary to facility policy and procedure. The IP emphasized the importance of tracking all antibiotics to ensure appropriate use and monitoring, especially for residents with a history of resistance and susceptibility to infections. The Director of Nursing (DON) also confirmed that antibiotics are considered high-risk medications and that the facility's policy requires all antibiotics to be included in the ASP for proper evaluation of continued need. The DON stated that the prescribed methenamine hippurate should have been included in the ASP but was not, indicating that facility policy and procedure were not followed in this instance. The facility's policies and job descriptions further outlined the responsibilities for tracking, monitoring, and reporting antibiotic use, which were not adhered to in this case.