Failure to Implement Effective Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement an Antibiotic Stewardship Program that adhered to current standards of practice for prescribing antibiotics, as evidenced by the review of three residents' records. For one resident with a diagnosis of malignant neoplasm of the spinal cord, antibiotics were prescribed for urinary symptoms without supporting laboratory results or documentation of symptoms consistent with McGeer's criteria for urinary tract infection (UTI). The Infection Preventionist (IP) confirmed the absence of lab results and appropriate documentation, making it impossible to verify the necessity or appropriateness of the antibiotic prescribed. Another resident, admitted with malignant neoplasm of the kidney and chronic obstructive pulmonary disease, was prescribed antibiotics following a urinalysis that showed abnormal findings. However, there was no documentation in the nurses' notes regarding the resident's symptoms or the rationale for ordering the urinalysis. The IP confirmed that this case also did not meet McGeer's criteria due to the lack of documented symptoms prior to testing. Additionally, the urine culture later revealed the presence of two organisms, one of which was not susceptible to the prescribed antibiotic. A third resident, with type two diabetes mellitus, returned from the emergency room with an order for antibiotics for a urine infection, but there was no laboratory evidence or documentation of symptoms to support the need for antibiotics. The facility's infection tracking documentation lacked consistent information on whether infections met McGeer's criteria, details of antibiotic use, signs or symptoms, and culture results. The Director of Nursing stated that the expectation was for nurses to follow updated policy and document appropriately, but the only policy provided was outdated and did not ensure compliance with current standards.