Failure to Administer Prescribed Antibiotic Due to Unavailability
Penalty
Summary
The facility failed to ensure that a resident was free from significant medication errors by not administering a prescribed antibiotic, Fidaxomicin, as ordered by the physician. The resident, an 83-year-old with diagnoses including diverticulitis with perforation and abscess, lower abdominal pain, bipolar disorder, and a history of C. difficile infection, was admitted with a physician's order for Fidaxomicin 200 mg twice daily for 10 days. Review of the medication administration record and progress notes confirmed that the antibiotic was not administered from admission through the review period, with documentation indicating the medication was not available. Nursing staff and the DON reported that the medication was not in stock, was expensive, and not included in the emergency kit, and that attempts were made to contact the infectious disease doctor for alternatives, but no alternative was provided or documented. The resident and her representative both confirmed that the prescribed antibiotic was not given since admission. The DON stated that the pharmacy indicated a delay in obtaining the medication and that she attempted to contact the infectious disease doctor and the hospital for clarification, but did not document all communication attempts. The physician assistant confirmed that there was no approved alternative for the resident's condition and was not aware the medication was never administered. There was no documentation in the medical record regarding the reason for holding the antibiotic or the anticipated delivery date, and no evidence of discontinuation or substitution by the medical team.