The facility failed to implement an Antibiotic Stewardship Program to review antibiotic appropriateness and track antibiotic use. Two residents received antibiotics, including one IV antibiotic with no stop date and one oral antibiotic course, but neither resident was listed on the facility’s line listing for infections or antibiotic use. The IP stated antibiotics were reviewed using McGeer’s criteria and should have been included on the tracking tool.
The facility failed to implement its ASP for 3 residents receiving prophylactic antibiotics. One resident received Cephalexin for UTI prophylaxis, another received Macrodantin nightly for UTI prophylaxis, and a third received Fosfomycin every 10 days for UTI prophylaxis, all without clear stop dates or adequate documentation supporting continued use. Interviews confirmed the DON, Medical Director, and Administrator lacked consistent documentation and follow-through regarding the rationale for ongoing antibiotic prophylaxis.
A facility failed to implement its Antibiotic Stewardship Program for a resident who received an ABO for a bilateral leg skin infection. The resident had redness, warmth, and tenderness, but review of updated McGeer's criteria showed the condition did not meet infection criteria, and the Wound Nurse/IP stated it should have been reported to the provider for review.
Antibiotic stewardship was not effectively implemented for three residents. One resident remained on long-term Cephalexin for chronic cystitis without an end date, while two other residents had antibiotic orders and surveillance log entries that did not match McGeer criteria or were not fully documented, including missing end dates, incomplete infection indications, and antibiotics not reflected on the surveillance logs. The IP stated some residents did not meet criteria and that provider discussions and reassessments were not documented.
Failure to Implement Antibiotic Stewardship Program: The facility did not complete required antibiotic reassessments for two residents receiving antibiotics for suspected UTIs. One resident with Parkinson's disease received multiple antibiotic courses, including treatment based on delayed lab susceptibility results, but the record showed no documented UTI signs or symptoms and no McGeers assessment or antibiotic reassessment. Another resident with a broken leg received Macrobid for a UTI, but no lab results were reviewed and no antibiotic reassessment was completed; progress notes also showed no UTI symptoms.
Antibiotic stewardship was not effectively implemented for two residents reviewed for UTI treatment. One resident received full courses of Bactrim DS and levofloxacin after contaminated urine cultures showed >3 organisms and documentation stated McGeer’s criteria for UTI were not met, with no record that the urine was recollected or that the provider was notified before antibiotics were completed. Another resident received Augmentin for a UTI after a contaminated urine culture, despite later notes showing no dysuria and the infection report stating McGeer’s criteria were not met; staff also acknowledged there was no UA/C&S pending and no known organism susceptibility.
Antibiotic stewardship was not consistently maintained, and standardized criteria such as Loeb Minimum Criteria were not used for antibiotic initiation. One resident received Macrobid for UTI despite an infection surveillance form showing symptoms but no qualifying microbiologic criteria, and another resident received nitrofurantoin for UTI even though the urine culture colony count did not meet McGeer criteria. The DON stated McGeer criteria were used for both starting antibiotics and infection surveillance, and that SBAR and Loeb’s criteria were not used.
Failure to monitor and document appropriate ABO use: the facility did not fully implement its ABO stewardship program for two residents. One resident received an antibiotic for a UTI even though the infection preventionist stated McGeer and Loeb criteria were not met and the provider did not document why the ABO was ordered. Another resident had two wound-related ABO orders tied to a wound vac, but after the wound vac was discontinued, staff did not document contacting the provider about whether the ABOs should continue until two weeks later, when the wound was noted to have no signs of infection.
Surveyors found that the facility lacked an Infection Prevention and Control Program that included an antibiotic stewardship component. During an interview, the DON could not locate any IPCP documentation and reported being unaware of any system used to track antibiotic use. As a result, there was no structured process in place to monitor or manage antibiotic prescribing and usage, as required by WAC 388-97-1620(2)(b)(i)(ii).
Failure to Monitor Antibiotic Use: The facility did not consistently apply its antibiotic stewardship process for three residents. One resident received Cipro despite a urine culture below the facility’s UTI threshold and no genitourinary symptoms, another had a low-count urine result with blank infection tracking before later receiving an antibiotic, and a third had an antibiotic ordered by an outside provider without a urinalysis or completed infection assessment. For all three residents, there was no documented antibiotic time out or rationale for continued use.
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