Failure to Monitor and Evaluate Antibiotic Use
Penalty
Summary
The facility failed to monitor and evaluate antibiotic usage for three of six residents reviewed for antibiotic use. For one resident admitted with a urinary tract infection (UTI), the medical record showed the resident was prescribed two different broad-spectrum antibiotics (Cefuroxime and Cipro) without proper infection screening or completion of McGeer's criteria by the Infection Preventionist (IP). The IP did not clarify the antibiotic order with the nurse practitioner or ensure a urine analysis (UA) and culture were ordered, despite hospital lab results indicating a contaminated specimen and the need for a repeat test. The IP confirmed that infection screening was not completed and that she did not communicate with the prescriber regarding the need for appropriate diagnostic testing before starting antibiotics. Additionally, two other residents were started on antibiotics for urinary infections without proper documentation or adherence to established criteria. One resident was started on Keflex and later Cipro despite negative UA and culture results, and another was started on Cipro for a change in condition without available UA and culture results. The IP was unaware of one resident's prophylactic antibiotic use and acknowledged that the antibiotic order did not meet McGeer's criteria. The IP also stated that she does not routinely discuss antibiotic initiation with the medical director or nurse practitioners before diagnostic results are available. These failures were identified through interviews, record reviews, and policy review, and were found to be inconsistent with CDC guidance and the facility's own antibiotic stewardship policies.