F0881

E

Failure to Maintain Effective Antibiotic Stewardship and Document Appropriateness of Therapy

Bloomfield Hills, Michigan Survey Completed on 01-14-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to maintain an effective antibiotic stewardship program and to monitor the appropriateness of antibiotic use for two residents. For one resident with a history of anxiety disorder, bipolar disorder, and adjustment disorder, an Infection Report Form dated with an onset of 12/16 documented mental status change, lethargy, and fever, and initiation of cephalexin 500 mg three times daily for 10 days. However, the attached McGeer Criteria Worksheet was left blank, and the medical record contained no documentation supporting the reported mental status change, lethargy, or fever. Nursing notes instead described the resident calling 911 due to perceived mold on the floors and difficulty breathing, with normal vital signs and lung sounds, and multiple entries reflecting disruptive behaviors, yelling, refusals of care, irritability, agitation, and frustration that appeared to be baseline. After the resident was transferred to the hospital and returned, new orders were received for cephalexin 500 mg three times daily for 10 days for a mild UTI, but there was no documentation in the record of any review of the appropriateness of the antibiotic or of hospital labs or culture reports.

For the second resident, with diagnoses including paranoid schizophrenia, psychotic disorder with hallucinations, and adjustment disorder, an Infection Report Form with onset 12/11 listed Augmentin 500-125 mg every 12 hours but left the signs and symptoms section blank, and the attached McGeer Criteria Worksheet was also blank. A UA and culture showed E. coli >100,000 in the urine, but a NP note on the same date documented the resident as somewhat irate and wanting to go home, with no complaints, no respiratory distress, no discomfort, and no pain, and referenced recent verbal and physical aggression and a history of behavioral issues. The December MAR showed multiple Augmentin orders for UTI with start and stop dates resulting in incomplete courses before a full 7‑day regimen was completed, yet the record contained no documentation that the resident met infection criteria or that the appropriateness of the antibiotic therapy was reviewed. During interview, the ICP stated they run a daily report of residents on antibiotics and contact the physician to review antibiotics but acknowledged they had just realized such reviews should be documented, and no documentation of antibiotic appropriateness review for these two residents was provided by the end of the survey.