Failure to Ensure Appropriate Antibiotic Use Without Confirmed Infection
Penalty
Summary
The facility failed to ensure that antibiotics were not used without the presence of a diagnosed infection for one of three residents reviewed for antibiotic stewardship. According to the facility's policy, the Infection Control Coordinator or designee is required to complete a surveillance document using the McGeer criteria to confirm evidence of infection before antibiotics are administered, and to contact the physician if the criteria are not met. For one resident, documentation showed that doxycycline was prescribed for an upper respiratory infection, but the infection control log lacked information on the organism, x-ray results, lab or culture results, and did not include a section for symptoms or whether the infection met the required criteria. The resident's chest x-ray indicated no active disease or evidence of pneumonia, and there was no documentation of communication with the physician regarding the continued use of antibiotics in the absence of an active infection. The Infection Preventionist (IP) reported that she had not reviewed lab or x-ray results as part of the antibiotic stewardship program and relied on nurses' notes to determine the effectiveness of antibiotics. The IP also stated she did not have a process to determine if the prescribed antibiotic was appropriate based on organism susceptibility, as she did not have access to lab results. The IP confirmed that she had not reviewed the resident's use of doxycycline to determine if the infection met criteria or if the antibiotic was appropriate, and had not seen the relevant chest x-ray results.