Failure to Justify and Monitor Antibiotic Use per Stewardship Protocols
Penalty
Summary
The facility failed to justify the use of antibiotics and did not utilize proper infection surveillance when initiating antibiotics for two residents. In one case, the Infection Preventionist was unable to effectively use the McGeer criteria to determine if a resident qualified for a true urinary tract infection (UTI), and the decision to obtain a urine culture was based on a family request rather than clinical symptoms. The resident was subsequently prescribed Levaquin for a UTI, but the infection analysis section of the screening evaluation was left blank, indicating a lack of documented clinical justification for the antibiotic order. In another instance, a resident with a history of multiple UTIs was started on prophylactic antibiotics without obtaining a urine culture prior to initiation. The Infection Preventionist admitted that infection screening forms and analyses were not completed, and the last urinalysis on record was from the previous year, which showed no growth. The nurse practitioner confirmed that prophylactic antibiotics are not typically prescribed without urology consultation and that McGeer criteria are used to guide antibiotic initiation, which was not followed in this case. The facility's own antibiotic stewardship policy requires assessment using McGeer criteria and consideration of urinalysis and cultures, which was not adhered to for these residents.