Excess Nitrofurantoin Dosing and Subsequent Yeast Infection
Penalty
Summary
The deficiency involves the facility’s failure to administer medications as ordered for a resident admitted with multiple diagnoses including diabetes, hypothyroidism, arthritis, dementia, history of falls, low back pain, hypertension, history of stroke, and a UTI. Hospital discharge instructions and a nurse practitioner note specified that the resident was to receive Nitrofurantoin 100 mg every 12 hours for a total of two doses to complete treatment for a UTI after admission. The physician orders in the facility’s EMR reflected Nitrofurantoin 100 mg twice daily for UTI for two administrations with a start date of 1/7/2026, and a second, similar order with a start date of 1/12/2026. Review of the January MAR showed the resident actually received 7 doses of Nitrofurantoin from 1/7/2026–1/11/2026, with missed doses on the morning of 1/9/2026 and the evening of 1/11/2026, and then 3 additional doses from 1/12/2026–1/13/2026 under the new order, for a total of 10 doses instead of the 2 doses ordered. Subsequently, provider encounter notes documented that the resident reported symptoms consistent with a yeast infection, including vaginal itching, burning, and white discharge. On 1/13/2026, a physician documented candidiasis and ordered Diflucan, and on 1/15/2026 an NP documented a vaginal yeast infection with intense itching and white discharge and ordered Diflucan and miconazole vaginal suppositories, which were initiated on 1/16/2026. The ADON, when interviewed, confirmed she had entered the Nitrofurantoin order for two doses and stated she did not know why the resident received so many doses, acknowledging that the resident developed a yeast infection and was very uncomfortable after receiving extra antibiotic doses. The DON reported there was no additional information explaining why more Nitrofurantoin doses were given than ordered. The resident’s care plans included interventions to administer medications as ordered and observe for side effects and effectiveness for both the UTI and subsequent vaginal yeast infection.
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