Failure to Monitor Residents for Adverse Effects During Antibiotic Therapy
Penalty
Summary
The facility failed to implement its antibiotic stewardship program by not ensuring that residents receiving antibiotics were properly monitored for adverse effects and effectiveness of the medication. For one resident with metabolic encephalopathy, sepsis due to MRSA, and dementia, there was no documented evidence that monitoring was performed during the administration of vancomycin, despite physician orders and care plans indicating the need for such monitoring. The Infection Preventionist confirmed that no monitoring was documented on specific dates, and the Director of Nursing acknowledged the failure to monitor for possible side effects. Another resident with chronic osteomyelitis, diabetes, and MRSA infection was prescribed cephalexin for a bilateral foot infection. The order summary did not include instructions to monitor for adverse effects, and there was no care plan addressing the use of cephalexin. The Infection Preventionist and Director of Nursing both stated that monitoring for adverse effects was not performed, and the facility's policy required such monitoring as part of its antibiotic stewardship program. A third resident with cerebrovascular disease, major depressive disorder, and vascular dementia was prescribed cephalexin and later Bactrim for a urinary tract infection. Although care plans were in place to assess for adverse reactions, there was no documented evidence of monitoring for adverse effects on multiple days during the course of antibiotic therapy. The Infection Preventionist confirmed the lack of documentation and emphasized the importance of monitoring to determine the effectiveness of the antibiotics and to prevent complications.