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).
The facility did not obtain or document required laboratory results to support antibiotic treatments for two residents admitted with infections, as required by its antibiotic stewardship policy. The Infection Preventionist confirmed that staff failed to collect necessary supporting data at admission, resulting in incomplete records for antibiotic use.
The facility did not have a program in place to monitor antibiotic use, lacking a system to track or evaluate antibiotic administration among residents.
A facility failed to ensure that antibiotic initiation for UTIs was based on CDC-approved criteria. The Antibiotic Stewardship Policy did not specify which symptom criteria to use, and staff reported using an SBAR tool referencing McGeer's criteria for initiating antibiotics, contrary to federal regulations that require Loeb minimum criteria for this purpose.
The facility did not ensure accurate and complete documentation of infection signs and symptoms on monthly line listings and failed to consistently apply McGeer's Criteria for antibiotic use. A resident with a history of Bullous Pemphigoid received two courses of antibiotics for cellulitis without meeting required criteria or proper documentation, and staff interviews confirmed inconsistent communication and record-keeping regarding infection assessments and antibiotic initiation.
The facility did not follow its Antibiotic Stewardship Program for new admissions or residents prescribed antibiotics by community providers, as shown by incomplete or missing documentation of McGeer Criteria in infection surveillance logs over several months. The Infection Preventionist confirmed the ASP process was not applied in these cases, assuming hospitals ensured compliance.
The facility did not ensure complete and accurate documentation or evaluation of antibiotic use for three residents, including missing infection details, lack of timely culture results, and failure to notify providers when prescribed antibiotics were not indicated or when organisms were resistant. The Infection Preventionist confirmed these lapses, which included incomplete logs and missing provider notifications.
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