Health inspection·January 19, 2024

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed perform antibiotic stewardship for 2 of 3 residents (R27, R39) reviewed for antibiotic stewardship in the sample of 29. Residents Affected - Few Findings include: 1. R27 was documented on the Infection Control log, dated 1/3/2024, for a urine infection. The organism documented was Enterococcus aerogenes. R27's Progress Notes, dated 1/3/2024, documented, Patient with urinary retention, suprapubic discomfort at times, leukocytosis. UA (urinary analysis) positive. Awaiting final urine culture. Patient has a history of pyelonephritis with pansensitive E. coli. We will start cefdinir 300 mg (milligrams) for 7 days. Adjust if needed once culture available. R27's Culture and Sensitivity Report, dated of 1/2/2024 at 3:14 PM, documented, Organism 1L Enterobacter aerogenes, and documents the organism was resistant to cefdinir. R27's Medication Administration Record (MAR) for January 2024 documented, Cefdinir (Cefzon, Omnicef) 300 milligrams (mg) oral capsule, start date 1/3/2024. R27's MAR also documents R27 received a total of four doses, January 3-January 4,2024 for a urinary tract infection. 2. R39 was documented on the infection control log,dated 1/7/2024, for urine infection. R39's Progress Notes, dated 1/8/2024 at 1:08 PM, Urinary tract infection associated with indwelling urethral catheter, initial encounter (HCC). Assessment Plan: Urine cloudy, continues to have good output from catheter. Culture positive for probable pseudomonas growth, awaiting sensitivities. Continues cefdinir for now, will adjust medication if needed once sensitivities available. R39's Urine Culture report, dated 1/7/2024 at 11:35 AM, documented, Final report organism 1: Pseudomonas aeruginosa. Cefdinir (Cefzon, Omnicef). The organism was not documented as being sensitive or resistant to cefdinir. R39's MAR, dated January 2024, documented, Cefdinir 300 mg, 1 capsule two times a day for seven days. Start date 1/7/2024. it continued to document that R30 received four doses from 1/7/2024 to 1/10/2024. The facility's Antibiotic Report, dated January 2024, documented that Cefdinir as being resistant to pseudomonas aeruginosa. Page 1 of 2 145102 145102 01/19/2024 Memorial Care Center 4315 Memorial Drive Belleville, IL 62226

F 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R39's MAR, dated January 2024, documented, a 1/9/2024 start date for Ciprofloxacin (Cipro 500 mg) oral tablet every 12 hours for urinary tract infection for 7 days. R39's MAR document R39 received 7 days of the medication. The facility's Antibiotic Report, dated January 2024, documented for R39 that Cipro as being Sensitive for pseudomonas. On 1/17/2024 at 4:46 PM, V3, Infection Control Specialist, stated, Sometimes the PA (Physician Assistant) will start the antibiotics before the Culture and Sensitivity comes back but they do a good job of following up with them and making sure they are the correct antibiotics once the culture has been returned. When the physician sees the C & S it shows up on their screen the exact name of the medications and if they are resistant or have sensitivity. I myself, when I get the report there is only one or two letters for the drugs. I have a sheet from the pharmacy documenting what drug is what. R27's MAR, dated January 2024, also documented an order, Sulfamethoxazole-trimethoprim, (Bactrim DS (double strength), 800 mg to 160 mg, oral tablet. Start date 1/5/2024. The Antibiotic Stewardship Program Policy, dated of 9/22, documented, To provide guidelines to optimize the treatment of infections while reducing the adverse events associated with antibiotic use. It is the policy of this community to implement an Antibiotic Stewardship Program as part of the community's overall infection prevention and control program. It promotes the appropriate use of antibiotics and is a system of monitoring to improve resident outcomes and reduce antibiotic resistance. Antibiotics will be prescribed for the correct indication, dose and duration to appropriately treat the resident while attempting to reduce the development of antibiotic-residents organisms or other adverse consequences or outcomes. This program will be reviewed on an annual basis and as needed. 145102 Page 2 of 2