Failure to Implement and Document Antibiotic Stewardship Time-Outs
Penalty
Summary
The deficiency involves the facility’s failure to establish and implement an Infection Prevention and Control Program that includes an antibiotic stewardship program with antibiotic use protocols and a system to monitor antibiotic use, specifically the lack of documented antibiotic “time outs” or day-three reviews. For five residents receiving antibiotics, clinical record review did not show evidence that a review was conducted two to three days after antibiotic initiation to determine if a bacterial infection was present, whether the antibiotic, dose, and route were appropriate, or if therapy could be narrowed or shortened. One resident admitted with dementia received Doxycycline 100 mg twice daily for 10 days, and another resident with diverticulitis of the large intestine received Doxycycline 100 mg twice daily for seven days, with no documentation of an antibiotic time out or day-three review for either course. A resident admitted with pneumonia received Cefpodoxime Proxetil 200 mg twice daily for seven days, another resident with dementia received Clindamycin 300 mg three times daily for 10 days, and a resident with sepsis received Meropenem 500 mg IV every 12 hours for six days; in all three cases, records lacked documentation of an antibiotic time out or day-three review. During an interview, the Infection Preventionist stated that antibiotics are discussed verbally at staff meetings but that antibiotic time outs or reviews are not documented unless there is a physician’s order. In a subsequent interview, the Director of Nursing Services was unable to provide evidence that antibiotic time outs or reviews had been completed for these residents.
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