Failure to Ensure Antibiotic Orders Had End Date or Justification
Penalty
Summary
The facility failed to ensure that a resident’s drug regimen was free from unnecessary drugs by not providing an end date or documented justification for the continued use of a prophylactic antibiotic. The resident in question had multiple diagnoses, including multiple sclerosis, neuromuscular bladder dysfunction, and a kidney stone, and was dependent on staff for toileting and had a suprapubic catheter. Despite the original order for Ciprofloxacin being intended for a limited duration following a surgical procedure, the antibiotic was continued without an end date or clear clinical justification. Documentation showed that the pharmacy flagged the ongoing use of Ciprofloxacin and requested clarification on the duration of therapy, but the provider only handwrote 'prophylactic-urology' without specifying an end date. Interviews with nursing staff, the PA, and the DON revealed that staff were aware of the missing end date and the lack of justification for continued antibiotic use, but failed to follow up adequately with the prescribing urologist or to document any resolution. The medical record lacked evidence of appropriate follow-up or communication with the urology clinic regarding the necessity and duration of the antibiotic. Facility policy required that all antibiotic orders include a duration and that any discrepancies be clarified with the provider. Despite this, the resident continued to receive Ciprofloxacin without a documented indication or stop date, and there was no evidence that the facility’s antibiotic stewardship protocols were followed. The deficiency was further supported by the absence of documentation of follow-up actions or provider responses in the resident’s medical record.