Inappropriate Antibiotic Prescribing for UTI
Penalty
Summary
A resident with multiple complex medical conditions, including encephalopathy, diabetes, aphasia, and hemiplegia, was admitted to the facility and later experienced a change in condition. Following abnormal urinalysis results, the on-call physician was notified and a verbal order was given for Macrobid, an antibiotic, to be administered. The resident received at least one dose of Macrobid as documented in the medication administration record. However, subsequent review by a certified nurse practitioner revealed that Macrobid did not cover the organisms identified in the resident's urine culture, specifically Klebsiella pneumoniae, which was not sensitive to Macrobid according to the sensitivity testing. The facility's policy on antibiotic stewardship requires the use of antibiograms and lab results to guide appropriate antibiotic selection. Despite this, the initial antibiotic prescribed was not effective against the identified bacteria. The Assistant Director of Nursing confirmed that Macrobid did not meet the criteria for administration in this case. This failure to ensure the resident was ordered an appropriate antibiotic for a urinary tract infection constituted a deficiency, as it did not align with the facility's established protocols for infection control and antibiotic stewardship.