Failure to Complete Timely Antibiotic Time-Outs for Two Residents
Penalty
Summary
The facility failed to ensure that an antibiotic time-out (ATO), a structured process for reviewing and assessing the need for ongoing antibiotic therapy, was completed within 48 to 72 hours for two residents who were prescribed antibiotics. According to the facility's policy, an ATO should be performed within this timeframe to reassess the necessity of the antibiotic based on clinical and laboratory data, and to communicate findings with the prescribing physician. However, record reviews and interviews confirmed that ATOs were not completed for these residents within the required period after antibiotic initiation. One resident was admitted with chronic kidney disease, urinary tract infection, and enterocolitis due to Clostridium difficile, and was prescribed metronidazole. The medication administration records showed that the resident received the antibiotic as ordered, but there was no documentation of an ATO being completed within the 48 to 72-hour window. Another resident, admitted with heart failure, bacteremia, and end-stage renal disease, was prescribed ciprofloxacin following a surgical procedure. Similarly, the records indicated the antibiotic was administered as ordered, but an ATO was not documented within the required timeframe. Interviews with the Infection Preventionist, Registered Nurse Supervisor, and Director of Nursing confirmed that the ATOs for both residents were not completed as per facility protocol. The staff acknowledged that the ATOs should have been performed within 48 to 72 hours after starting the antibiotics, as outlined in the facility's policies on antibiotic stewardship and ATO procedures. The absence of timely ATOs was verified through both electronic medical chart reviews and staff statements.