Failure to Monitor and Appropriately Administer Antibiotics
Penalty
Summary
The facility failed to ensure appropriate antibiotic use and infection control for a resident, resulting in prolonged and overlapping antibiotic therapy without adherence to accepted standards. The resident was prescribed multiple antibiotics over several months, including Bactrim, Vancomycin, Ciprofloxacin, Macrobid, and Cefdinir, often for urinary tract infections (UTIs) and sinusitis. There were instances where two different antibiotics were administered simultaneously for the same UTI, and changes in antibiotic regimens were made without documented rationale. The resident's medication administration records showed overlapping courses and incomplete documentation regarding discontinuation and switching of antibiotics. Additionally, the facility did not have an infection preventionist at the time of the survey, and infection tracking was not performed as required. Staff were unaware of the resident receiving two antibiotics concurrently for the same infection. The resident repeatedly tested positive for Escherichia coli/Extended Spectrum Beta Lactamase (ESBL) in urine cultures and contracted Clostridium difficile during this period. These findings indicate a lack of oversight and monitoring of antibiotic use and infection control practices for the resident involved.