Failure to Implement Antibiotic Stewardship Protocols
Penalty
Summary
The facility failed to implement appropriate antibiotic stewardship for one resident who was admitted with multiple diagnoses, including a urinary tract infection (UTI). Medical record review showed that the resident was cognitively intact, frequently incontinent of urine, and had a recent history of UTI. The resident had an indwelling urinary catheter for a period prior to the incident. On a specific date, the resident complained of back pain and dysuria, and cloudy urine was observed. A urinalysis was sent for analysis, but a prophylactic antibiotic (Bactrim) was started before the urinalysis and urine culture results were available. The resident continued to receive Bactrim pending the results, and fluids were encouraged. The urine culture later revealed the presence of Escherichia coli (sensitive to Bactrim) and enterococcus faecalis (not sensitive to Bactrim). The resident was then started on a different antibiotic (Cipro) after the culture results were received. An interview with an LPN confirmed that antibiotics were started prior to receiving test results, and that the physician assistant routinely orders antibiotics prophylactically without confirming appropriateness. Facility policy required assessment and diagnostic testing to guide antibiotic use, but this protocol was not followed in this case. This deficiency was identified during a complaint investigation.