Failure to Adhere to Antibiotic Stewardship Protocols for UTI Treatment
Penalty
Summary
The facility failed to ensure that residents were not treated with antibiotics for urinary tract infections (UTIs) unless they met established criteria for treatment. In two cases, residents were administered antibiotics despite not meeting McGeer's criteria, which are standardized definitions used for surveillance of healthcare-associated infections in long-term care facilities. The infection control log indicated that for both residents, the criteria for initiating antibiotic therapy were not met, and no urinalysis with culture and sensitivity was performed to confirm the presence of a UTI. For one resident with a history of chronic UTIs, Levofloxacin was prescribed by her urologist, and the antibiotic course was continued even after it was determined that she did not meet the criteria for treatment. The DON, who also served as the Infection Preventionist, confirmed that the nurse practitioner and attending physician did not question the need for the antibiotic, and the nurse practitioner instructed staff to continue the antibiotic as ordered, despite the lack of supporting clinical evidence. In the second case, a resident in the memory care unit received Macrobid for a suspected UTI, but again did not meet the criteria for treatment and did not have a urinalysis performed. The resident was experiencing urinary retention and had an indwelling catheter placed, but no other symptoms were documented. The DON acknowledged that urinary retention could be due to other causes and was unable to provide documentation supporting the necessity of the antibiotic. The nurse practitioner was aware of the situation and directed that the antibiotic be continued, even though the resident did not meet McGeer's criteria.