Failure to Implement Antibiotic Stewardship Program Protocols
Penalty
Summary
The facility failed to implement its antibiotic stewardship program in accordance with its own policies and protocols for two residents out of a sample of thirteen. The facility's policy required that all antibiotic use be documented on an approved surveillance tracking form, with specific information such as resident details, symptoms, infection site, culture dates, and clinical rationale for antibiotic initiation. The policy also mandated that the Infection Preventionist (IP) review all clinical infections treated with antibiotics and ensure that antibiotic use was consistent with established criteria, specifically the McGeer criteria for infection assessment. For one resident, the antibiotic surveillance tracking form indicated a urinary tract infection (UTI) and antibiotic prescription, but there were insufficient symptoms documented to meet the McGeer criteria for infection. The medical record did not contain a clinical rationale from the prescribing physician for starting the antibiotic, and the IP confirmed that the criteria for antibiotic initiation were not met. Similarly, for another resident, the tracking form showed a positive urine culture and antibiotic prescription for a UTI, but again, no symptoms were documented to meet the McGeer criteria, and no clinical rationale was provided by the physician. The IP acknowledged that the antibiotic was prescribed without meeting the required criteria or documentation. Interviews with the DON, who also served as the IP, confirmed that the facility used the McGeer criteria to define infections and that all antibiotic regimens should be reviewed and documented according to the stewardship program. Despite these protocols, antibiotics were prescribed and administered to two residents without sufficient clinical justification or adherence to the facility's established antibiotic stewardship procedures.