Health inspection·December 28, 2023

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of medscape, the facility failed to ensure residents were not prescribed unnecessary antibiotic medications. This affected one (Resident #12) out of five residents reviewed for unnecessary medications. The current census is 44. Residents Affected - Few Findings include: Record review for Resident #12 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #12 include Alzheimer's, dementia with behaviors, chronic kidney disease, and schizophrenia. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition and was receiving antibiotics. Per the assessment the resident had not been diagnosed with a urinary tract infection in the past 30 days. Review of Resident #12's care plans dated 12/27/21 revealed the resident was at for risk of chronic urinary tract infections. Interventions include administer medication per order, monitor for signs and symptoms of infections, avoid irritants, avoid tight pants, and assist with incontinence. Review of Resident #12's physician orders revealed on 04/25/23 the resident was ordered to receive Macrodantin oral antibiotic 50 milligrams (mg) 1 capsule daily for prophylaxis of urinary tract infections (UTI). Per the orders the Macrodantin antibiotic was re-ordered on 11/07/23 to continue for prophylaxis antibiotics for UTI. Review of Resident #12's Medication Administration Record (MAR) dated from 01/2022 to 11/2023 revealed the resident had received the oral antibiotic per physician order. Review of Resident #12's urinalysis and culture and sensitivity tests dated 11/11/22 and 09/16/23 revealed the resident's urine did not contain bacteria causing urinary tract infections. Interview on 12/28/23 at 11:00 A.M. with the Infection Control Prevention nurse (ICP) Licensed Practical Nurse (LPN) #87, verified Resident #12 did not have any signs or symptoms of a urinary tract infection which would require an antibiotic treatment. LPN #87 verified the facility's medical director continued to prescribe the oral antibiotic for Resident #12 against the facility followed antibiotic stewardship protocols. Per the LPN #87, the medical director had stated Resident #12 will continue to receive the antibiotic in order to prevent future UTIs. Interview on 12/28/23 at 1:52 P.M. with the Medical Director revealed the physician prescribed the Page 1 of 2 365505 365505 12/28/2023 Village Green Rehabilitation and Healthcare Center 1315 Kitchen Aid Way Greenville, OH 45331

F 0757 Level of Harm - Minimal harm or potential for actual harm oral antibiotic for Resident #12 despite her not having any signs or symptoms of infection. The physician verified the resident did not have an active diagnosis for an urinary tract infection. The physician stated he felt the antibiotic was to be used prophylacticly to prevent the resident from getting an UTI and becoming sepsis. The physician verified the use of prophylactic antibiotics did not follow the facility's protocols for antibiotics. Residents Affected - Few Interview on 12/28/23 at 3:00 P.M. with the Director of Nursing (DON) #67 verified there was no facility policy regarding the unnecessary medication. Review of medication information from Medscape at https://reference.medscape.com/drug/macrobid-macrodantin-nitrofurantoin-342567 revealed Macrodantin is an antibiotic used to treat UTI's. Further review of the information revealed you should avoid using Macrodantin for long-term UTI suppression. Long-term use in the elderly may increase risk for pulmonary toxicity. Additionally, bacterial superinfections may occur with prolonged treatment. 365505 Page 2 of 2