Lack of Rationale and Ongoing Evaluation for Prophylactic Antibiotic Use
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary drugs, specifically regarding the ongoing use of prophylactic antibiotics for the prevention of urinary tract infections (UTIs) in three residents. For one resident with chronic kidney disease and a history of UTIs, a prophylactic antibiotic (Macrobid) was ordered and administered daily without documented rationale for its continued use. When this resident developed UTI symptoms and was prescribed an additional antibiotic (Bactrim), both antibiotics were administered simultaneously, yet there was no documentation justifying the ongoing use of the prophylactic antibiotic during this period. Another resident with Alzheimer's disease and a history of UTIs had been receiving daily Macrobid since hospital discharge for UTI symptoms, with no documentation in the electronic health record regarding the rationale for the continued prophylactic antibiotic use. The Infection Preventionist (IP) confirmed that tracking of prophylactic antibiotics was only done for the first month and that there had been no discussion with the medical provider about the ongoing need for the antibiotic in this case. A third resident with benign prostatic hyperplasia and a history of UTIs had been on prophylactic Macrobid since admission, with no end date or documented rationale for continuation. The IP and DON both indicated that decisions regarding prophylactic antibiotics were left to the provider's judgment, and there was no ongoing tracking or documentation of indications, side effects, or rationale for continued use. Facility policy referenced antibiotic stewardship, but in practice, there was no evidence of ongoing evaluation or provider feedback regarding these residents' antibiotic regimens.