Failure to Complete Antibiotic Time-Outs for Continued Use
Penalty
Summary
The facility failed to complete comprehensive assessments for continued use of antibiotics for two of three sampled residents reviewed for antibiotic stewardship. Specifically, after antibiotics were initiated for these residents, there was no evidence that an antibiotic assessment (time-out) was conducted within 48-72 hours to determine if criteria for continuation of the antibiotic were met, as recommended by CDC guidelines. The surveillance logs for the relevant months included documentation of infection onset, type of illness, signs and symptoms, and treatment, but lacked evidence that the effectiveness of the antibiotic or the need for its continuation was evaluated. For one resident prescribed Azithromycin, there was no documentation of an antibiotic time-out or communication with the provider after starting the medication. For another resident prescribed Doxycycline, while some clinical assessments were documented, there was no evidence of provider communication regarding the assessment. Interviews with facility leadership revealed that the administrator was aware of issues with providers not responding to antibiotic time-outs, but this concern had not been addressed with the medical director or at QAPI meetings. The DON stated that her expectation was for antibiotic stewardship monitoring to occur with each antibiotic started. However, the facility's antibiotic stewardship policy did not include a requirement for an antibiotic assessment (time-out) 48-72 hours after initiation to determine if continuation criteria were met.