Failure to Clarify and Discontinue Prolonged Antibiotic Therapy Due to Lack of Provider Coordination
Penalty
Summary
The facility failed to ensure proper coordination of care between the provider and an outside urology clinic, resulting in a resident receiving prolonged antibiotic therapy without appropriate justification or an established end date. The resident, who had multiple sclerosis, neuromuscular bladder dysfunction, and a history of kidney stones, was dependent on staff for toileting and had a catheter. After a urology visit, the resident was prescribed Ciprofloxacin for nephrolithiasis, but the order lacked a specified duration. The physician assistant (PA) continued to sign monthly orders for the antibiotic without an end date, and the pharmacy flagged the issue, requesting clarification, which was not adequately addressed. Multiple staff interviews revealed that when a resident returns from the hospital with new orders, it is standard practice for nurses to verify and clarify any discrepancies, such as missing end dates for antibiotics, by contacting the provider. In this case, although staff were aware of the missing end date and the ongoing use of Ciprofloxacin, there was no documented follow-up or resolution. The PA stated he attempted to contact the urology clinic but did not receive a response and continued the order regardless. The medical director confirmed there was no clinical justification for prophylactic antibiotic use in this situation and expected the provider to follow through with the specialist for clarification. Documentation in the resident's medical record was incomplete, lacking evidence of follow-up with the urology clinic or justification for continued antibiotic use. Progress notes indicated attempts to contact the urologist, but there was no record of any response or further action. The deficiency was further compounded by the lack of communication and documentation among nursing staff, the PA, and the urology clinic, resulting in the resident receiving unnecessary antibiotic therapy beyond the intended period.