Failure to Monitor and Document Antibiotic Use per Stewardship Protocols
Penalty
Summary
A deficiency was identified when a resident with a history of recurrent urinary tract infections (UTIs), neoplasm of the right kidney, and hypertension was prescribed Macrobid (nitrofurantoin) 100 mg daily as a prophylactic antibiotic for chronic UTIs. The physician's order for the antibiotic was open-ended, lacking a stop date, and was continued without documented evidence of current infection or symptoms. Medical records and progress notes indicated that the resident did not exhibit signs or symptoms of a UTI during the period the antibiotic was administered, and a urine dip was negative. There was also no documentation that a urinalysis was performed as ordered. The facility's antibiotic stewardship policy required that antibiotic orders include a duration of treatment, specifying start and stop dates or the number of days of therapy. The policy also emphasized monitoring antibiotic use and providing education on the risks associated with antibiotics. Despite this, the resident received ongoing prophylactic antibiotic treatment without adherence to these protocols, and the facility did not ensure that its antibiotic stewardship program included effective monitoring or protocols for antibiotic use as required.