Failure to Follow Antibiotic Stewardship Protocols for UTI Treatment
Penalty
Summary
The facility failed to ensure that prescribed antibiotics met established criteria for use and did not adequately assess the continued need for antibiotics for a resident with a urinary tract infection (UTI). The resident, who was cognitively intact and had an indwelling urinary catheter along with diagnoses of Parkinson's disease, dementia, and obstructive uropathy, was prescribed cefpodoxime after completing a previous course of Macrobid without improvement. The provider ordered a urinalysis and urine culture, with instructions to update the antibiotic based on culture and sensitivity results. However, the urine culture indicated likely contamination, and there was no evidence that the culture and sensitivity results were reviewed by nursing staff or that the provider was notified when sensitivities were not received. The clinical record lacked documentation that antibiotic stewardship guidelines were followed, including the completion of a 72-hour antibiotic time-out and review of the appropriateness of continued antibiotic therapy. The facility's infection preventionist confirmed that these steps were not completed and acknowledged that the antibiotic stewardship policy, which requires regular review of antimicrobial therapy, was not adhered to in this case.