Delay in Administration of IV Antibiotics Due to Authorization and Availability Issues
Penalty
Summary
A resident was admitted with diagnoses including sepsis due to pseudomonas, osteomyelitis of the right ankle and foot, and type 2 diabetes, and was ordered to receive intravenous antibiotics. Communication between the hospital and facility staff prior to admission established that the resident required Avycaz, an expensive intravenous antibiotic, or Fetroja as an alternative. The facility agreed to use Avycaz due to cost considerations. Upon admission, the infectious disease physician ordered ceftazidime 1.25 grams every eight hours, but the pharmacy informed staff that this dosage was not available, and Avycaz was the appropriate alternative. Despite early notification and ongoing communication about the need for Avycaz, there were delays in obtaining the medication due to a required billing authorization. The pharmacy requested approval to bill the facility for Avycaz, but the previous DON did not address the authorization in a timely manner. This resulted in missed doses of intravenous antibiotics for the resident. Documentation shows that the approval form was eventually signed and faxed to the pharmacy, but the medication was not delivered promptly due to ongoing cost and authorization issues. Interviews with facility staff, including the current DON, LPN, and pharmacy technician, confirmed that the delay in administering the ordered antibiotics was due to the unavailability of the correct dosage and the lack of timely authorization for the alternative medication. The LPN reported daily to the DON and ADON about the medication issues, but concerns were not addressed, leading to a significant medication error and a delay in treatment for the resident.