Failure to Implement and Monitor Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement and follow its Antibiotic Stewardship Program by not monitoring for inappropriate and unnecessary antibiotic use for four residents reviewed for antibiotic usage. The facility’s policy required that antibiotics be prescribed and administered under the guidance of the Antibiotic Stewardship Program, with staff education on stewardship and all antibiotic orders including drug name, dose, frequency, start date, stop date, route, and indication. The DON, who also served as Infection Preventionist, stated she shared the IP role with the Administrator, who was not a nurse, and acknowledged she was still learning antibiotic stewardship and had not expected to be the IP. She reported she was responsible for monthly antibiotic surveillance and review of prophylactic antibiotic orders with the nurse practitioner, but also stated that some residents remained on prophylactic antibiotics based on history of UTIs or resident/family preference. For one resident, Macrobid was started for a history of frequent UTIs despite no acute UTI at the time, with no stop date and no repeat urinalysis obtained before initiation, and the DON/IP had not reassessed the continued need since the start date. Another resident was placed on Cephalexin for UTI prophylaxis by hospice without an associated diagnosis or stop date, and the facility never collected a urinalysis or discussed the need for continued use with hospice. A third resident received Bactrim twice weekly for a personal history of UTIs, with no stop date, had never been diagnosed with an acute UTI in the facility, had no urinalysis collected there, and the DON/IP had not discussed ongoing use with the nurse practitioner. A fourth resident was admitted from a hospital on Nitrofurantoin for UTI prevention; the facility carried over the order based on history of UTIs, did not obtain a urinalysis before continuing the medication, and the DON/IP did not consult the nurse practitioner about the need to continue it.
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