Failure to Administer Ordered IV Antibiotic and Ensure Timely Physician Communication
Penalty
Summary
A deficiency occurred when the facility failed to administer an ordered intravenous (IV) antibiotic to a resident as prescribed, did not ensure timely transport for continued treatment, and did not promptly contact the prescribing physician. The resident was admitted with multiple complex diagnoses, including Fournier Gangrene, chronic kidney disease, urinary tract infection, and a colostomy. Upon admission, the resident had an order for Ceftazidime-Avibactam IV antibiotic to be administered twice daily. However, the facility's pharmacy was unable to supply the medication due to its instability, high cost, and the need for immediate use, and this information was not communicated prior to the resident's admission. The medication administration records show that the IV antibiotic doses were repeatedly marked as "Hold" over several days. Progress notes indicate that the facility staff attempted to contact the prescribing infectious disease physician and the hospital, but there was a delay in communication and obtaining alternative orders. The nurse practitioner at the facility gave an order to hold the antibiotic until the prescribing physician could be reached, but the physician was not notified of the issue until several days later. During this period, the resident remained stable and continued on oral antibiotics, but the prescribed IV antibiotic therapy was interrupted. Efforts to transport the resident back to the hospital for the required IV antibiotic were unsuccessful for several days due to the resident's bariatric status and the inability to secure appropriate ambulance services. The resident ultimately required readmission to the hospital and an additional six days of IV antibiotic therapy due to the interruption in treatment. Interviews with facility staff and the pharmacist confirmed that the facility was not equipped to provide the ordered medication and that there was a breakdown in communication regarding the resident's needs and the facility's capabilities.