Failure to Complete Comprehensive Antibiotic Assessments
Penalty
Summary
The facility failed to complete comprehensive assessments for the continued use of antibiotics for two of three sampled residents reviewed for antibiotic stewardship. According to CDC guidelines, residents started on antibiotics should be comprehensively reviewed within 48-72 hours to ensure the medication is effective, which involves evaluating current symptoms and laboratory results. However, review of the facility's infection control logs and medical records for two residents revealed that there was no documentation of an initial comprehensive assessment after antibiotics were prescribed. One resident, admitted with septic shock and diarrhea, was prescribed vancomycin for a C-diff infection, but the medical record lacked evidence of an initial assessment. Another resident, admitted with a duodenal ulcer and hemorrhage, was prescribed metronidazole and tetracycline for H. pylori, but similarly, no initial comprehensive assessment was documented. The facility's infection summary reports and logs included information such as resident names, infection dates, body systems affected, and medications, but did not provide evidence that criteria for continuation of antibiotic use were met. The DON confirmed that while symptoms were assessed and communicated to the physician, and Mcgreer's criteria were referenced, there was no accessible form for staff to document that criteria had been met. Additionally, the facility's policy required the use of Mcgreer's criteria and review of antibiotic therapy for appropriateness, but a copy of the criteria was not provided upon request.