Failure to Implement Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement its antibiotic stewardship program as required, resulting in the inappropriate use of antibiotics for three residents. For one resident with a history of abdominal wall abscess, anemia, endometrial cancer, MRSA infection, and fibromyalgia, the medical record showed that the resident did not meet McGeer's criteria for a urinary tract infection (UTI) based on culture results, yet antibiotic therapy was administered. The physician was not notified that the criteria for infection were not met. Similarly, another resident with a duodenal malignancy, bacterial infection, and a stage 2 sacral pressure ulcer received antibiotics for a skin and soft tissue infection (SSTI) despite only meeting two of the four required new or increasing signs or symptoms per McGeer's criteria. This resident was also omitted from the infection line list, and the physician was not updated regarding the lack of infection criteria. A third resident, with diagnoses including head injury, COPD, and atherosclerotic heart disease, was prescribed antibiotics for a respiratory tract infection (RTI) without documentation of any signs or symptoms meeting McGeer's criteria. The infection documentation only noted a sinus infection without further detail, and the physician was not informed that the resident did not meet the criteria for infection. In all three cases, the facility did not follow its own policy requiring communication of lab results and clinical status to the prescriber to determine the appropriateness of antibiotic therapy.