Failure to Follow Antibiotic Stewardship and McGeer’s Criteria for Pneumonia
Penalty
Summary
The deficiency involves the facility’s failure to implement an antibiotic stewardship program consistent with its policy and McGeer’s criteria when prescribing an antibiotic for one resident reviewed for antibiotic stewardship. The resident, admitted with Parkinson’s disease, was documented by nursing staff as not feeling well, with O2 saturation of 89–90% on room air improving to 96% on 2L oxygen, and a congested right upper lobe. A stat chest x-ray was ordered, which showed bilateral lower lobe infiltrates and a right pleural effusion. Based on these findings, a provider ordered Amoxicillin-Clavulanate 875-125 mg twice daily for seven days for bilateral lobe infiltrates, and the MAR showed the resident completed the full antibiotic course. The facility’s Potential Infection Evaluation dated two days after antibiotic initiation documented a normal temperature, O2 saturation of 89%, presence of COPD, age over 65, and no new or increased cough with purulent sputum, concluding that nursing home protocol criteria for a lower respiratory infection were not met and that the resident did not need an immediate antibiotic prescription but might need additional observation. The EMR showed no lab work prior to starting the antibiotic, no documented fever, and no change in function or mental status. The provider’s progress note confirmed the resident was started on Augmentin for pneumonia based on the chest x-ray. Review of the Infection Control Surveillance Log for the year revealed missing documentation of residents’ signs and symptoms, organisms from culture results when obtained, and whether McGeer’s criteria were met. The Infection Preventionist acknowledged that the Potential Infection Evaluation form used did not align with McGeer’s criteria, and the DON stated her expectation that residents’ symptoms meet McGeer’s criteria for antibiotic use, demonstrating that the facility did not consistently apply its Antibiotic Stewardship policy and McGeer’s criteria in this case.
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