Lack of Clinical Justification for Prolonged Prophylactic Antibiotic Use
Penalty
Summary
A review of medical records and interviews revealed that a resident with a history of urinary retention and a supra pubic catheter was prescribed a routine antibiotic, cephalexin, for prophylactic use. The antibiotic order, which began in 2019, was continued with updated orders and diagnoses over the years, including a recent order with no specified stop date and a diagnosis of 'Prophylactic measures, unspecified.' Documentation showed that the resident was taking the antibiotic for UTI prophylaxis, but there was no clear clinical rationale or specific indicators documented to justify the ongoing use of the antibiotic. Further review of progress notes and referral forms indicated that nursing staff questioned the reason for the continued prophylactic antibiotic, and the only documented justification was 'UTI prophylactic.' The Nurse Practitioner confirmed the antibiotic was ordered for prophylaxis. Reference to CDC guidelines in the report highlighted that UTI prophylaxis accounts for a significant proportion of antibiotic prescriptions in nursing homes, but there is little evidence to support this practice, especially in older adults. The facility failed to provide adequate clinical justification for the continued use of the antibiotic in this resident.