Failure to Ensure Appropriate Antibiotic Use and Monitoring
Penalty
Summary
The facility failed to ensure appropriate monitoring and administration of antibiotics for a resident with a history of multiple complex medical conditions, including urinary retention, obstructive and reflux uropathy, and an indwelling catheter. Over several months, the resident received multiple courses of antibiotics for urinary tract infections (UTIs), including Ciprofloxacin, Amoxicillin-Clavulanate, Nitrofurantoin, Cefepime, Ertapenem, Sulfamethoxazole-Trimethoprim, and Doxycycline. Record review revealed that, in several instances, antibiotics were administered without obtaining a urine culture and sensitivity to confirm the appropriateness of the prescribed medication. Specifically, after the resident returned from the emergency department, antibiotics were given without evidence of a culture and sensitivity being completed, and in another instance, Doxycycline was administered despite the absence of sensitivity results for that medication. Interviews with the DON and Director of Clinical Services confirmed that the facility did not obtain urinalysis or urine culture and sensitivity when residents returned from the hospital with antibiotic orders, even if the hospital had not completed those tests. This practice was inconsistent with the facility's own antibiotic stewardship policy, which requires review of discharge paperwork for antibiotic orders and communication of lab results to the prescriber to guide antibiotic therapy decisions. The failure to obtain and review appropriate laboratory data prior to administering antibiotics led to the deficiency identified during the survey.