Failure to Implement Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement its antibiotic stewardship program as required, specifically for three residents who were prescribed antibiotics. According to the facility's undated policy, protocols should be in place to optimize infection treatment and ensure antibiotics are prescribed appropriately, with residents assessed using standardized tools and criteria. However, record review showed that for three residents with severe cognitive impairment and diagnoses such as dementia and Alzheimer's disease, antibiotics were prescribed for conditions including urinary tract infection, COVID-19, and other infections. Despite these prescriptions, there was no documentation that the required Loeb minimum criteria forms were completed to justify the initiation of antibiotic therapy. During an interview, the MDS coordinator confirmed that the facility was supposed to use the Loeb minimum criteria forms when starting antibiotic therapy, but no such forms were found for any residents, including the three sampled. The coordinator was unable to account for the missing forms or confirm if they had ever been used, indicating a lack of adherence to the facility's own antibiotic stewardship protocols.