Failure to Monitor and Evaluate Antibiotic Use per Stewardship Program
Penalty
Summary
The deficiency involves the facility’s failure to monitor and evaluate antibiotic use for a resident in accordance with its antibiotic stewardship program. The Infection Control RN reported that the resident was sent to the hospital after vomiting yellow-green emesis and returned the same day with antibiotic orders for a urinary tract infection (UTI). The facility’s Infection Report Form listed an onset date of 10/13/25, a suspected healthcare-associated UTI, and documented orders for Keflex 500 mg every six hours from 10/14/25 to 10/18/25, followed by Macrobid 100 mg twice daily from 10/17/25 to 10/22/25. A McGeer Criteria for Infection Surveillance Checklist was started for this resident, but the criteria section was not completed. The Infection Control RN provided a spreadsheet indicating that the resident did not meet McGeer’s criteria for UTI, yet the antibiotics were continued. When asked why antibiotics were continued if criteria were not met, the RN stated they followed the hospital’s UTI diagnosis and that the attending physician wanted the antibiotics continued, but there was no documentation of this discussion. The Infection Control RN also stated they did not personally reassess residents after antibiotics were ordered and was unsure whether facility physicians assessed the relevance of the antibiotic therapy. These actions and omissions conflicted with the facility’s written Antibiotic Stewardship Program policy, which required monitoring response to antibiotics to determine ongoing need or adjustments, and review of antibiotic orders from consulting, specialty, or emergency providers for appropriateness.
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