Failure to Administer Ordered IV Antibiotic for Medically Complex Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide a prescribed IV antibiotic, Zerbaxa, to a resident as ordered following readmission from the hospital. The resident had multiple serious diagnoses, including ventilator-associated pneumonia, COPD, acute respiratory failure, MRSA pneumonia and sepsis, bronchopneumonia, traumatic brain injury, tracheostomy status, and gastrostomy status, and was not cognitively intact per the reentry MDS. Hospital discharge instructions ordered Zerbaxa IV every eight hours through a specified completion date, and the facility’s physician order sheet reflected Zerbaxa 3000 mg IV every eight hours for six days. The resident was NPO and dependent on a feeding tube, and Zerbaxa was only available as an IV medication, making IV access and timely administration essential to follow the ordered regimen. Upon the resident’s return to the facility, nursing staff documented that the resident arrived without IV access. On the following day, nursing staff attempted twice to place an IV line without success and then sent the resident to a nearby hospital for vascular access. At the hospital, a PICC line was placed, and one dose of Zerbaxa was administered, with instructions that staff were to continue the antibiotic through the previously prescribed end date. The resident returned to the facility the same day with the PICC line in place. However, the medication administration records (MAR and TAR) for December did not contain any order entries for Zerbaxa, and there is no documentation that any doses of Zerbaxa were administered at the facility. Nursing notes indicated that on one day the pharmacy reported being backed up and would send the antibiotic later that evening, and the DON later stated the resident missed multiple scheduled doses over two days. Interviews with the RN, physician, NP, and DON revealed that the facility was aware of difficulties obtaining the specialty compounded medication, including that Medicaid had denied payment and that the facility owner was reportedly unwilling to pay for it. The physician and an infectious disease physician had agreed that there was no substitute for Zerbaxa and that it was the only appropriate antibiotic for the resident’s infection. Despite this, the medication was not available and not administered at the facility, and the resident went without the ordered doses while remaining in the facility. The NP and physician both stated they were unaware during this period that the resident was not receiving the ordered Zerbaxa at the facility.
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