Unnecessary Antibiotic Administration Without Clinical Indication
Penalty
Summary
The facility failed to ensure that a resident's drug regimen was free from unnecessary antibiotics, as required by their Antibiotic Stewardship Program policy. The policy mandates that clinical symptoms of infection must be present before collecting cultures or starting antibiotics, and that empiric antibiotics should only be initiated if the resident meets specific clinical criteria and appears systemically ill. In the case reviewed, a resident with chronic obstructive pulmonary disorder and muscle weakness was administered Macrobid for a suspected urinary tract infection (UTI) at the request of the family, despite multiple progress notes and standardized urinary change forms documenting no signs or symptoms of a UTI. The resident's clinical record did not contain documentation of urinary symptoms that would meet the criteria for starting empiric antibiotic therapy, nor was there evidence that McGeer's criteria were met. The resident received two doses of Macrobid before laboratory confirmation of infection and before sensitivity results were available, which later showed resistance to Macrobid. The antibiotic was started solely based on abnormal urinalysis results and family request, without supporting clinical evidence or symptoms. The Director of Nursing acknowledged that antibiotics were initiated prior to culture confirmation and in the absence of documented clinical symptoms, contrary to facility policy and established infection surveillance criteria.