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.
Failure to Implement Effective Antibiotic Stewardship: Three residents were given antibiotics for presumed UTIs without the expected diagnostic support. One resident had bacteria noted on UA but no C&S was found before Bactrim DS was started, while two other residents were started on Cefpodoxime and Augmentin without a UA, C&S, or documented McGeer’s criteria supporting a UTI. Staff confirmed the missing testing and noted that one antibiotic had been prescribed by an outside specialist and another may have come from dialysis.
The facility did not consistently follow its antibiotic stewardship program or complete monthly surveillance, and antibiotic use was not formally tracked or reviewed in QAPI for several months. Records showed residents were placed on antibiotics during that period, but the infection line listing had no documentation of those uses. For one resident with hematuria and possible UTI, the chart did not show C&S results or that results were pending, yet an antibiotic was ordered for UTI.
Failure to Monitor ABO Use: The facility failed to implement its ABO stewardship program for two residents reviewed for unnecessary antibiotics. One resident received ABOs for a UTI and an upper respiratory infection, and another resident received an ABO for fever only. The Infection Preventionist stated the ABOs were not tracked on the stewardship line listing and did not have McGeers assessments or ABO time outs completed, despite the facility policy requiring those reviews.
Antibiotic stewardship monitoring was incomplete when the facility failed to consistently document signs and symptoms, review infections in meeting minutes, or record staff education for multiple months. A resident on prophylactic azithromycin for COPD also had no antibiotic time-out or documented reassessment, and the resident was not tracked on the antibiotic review lists. Staff reported relying on progress notes and memory for criteria review, but documentation was missing or incomplete.
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