Sandstone Health Care: Antibiotic Misuse Violations - MN
Sandstone Health Care Center failed to use established medical criteria to confirm the infection existed before requesting antibiotic orders for the resident, identified as R13 in federal inspection records from April 8.
The resident had multiple sclerosis, diabetes, paraplegia and dementia, along with an indwelling catheter and urinary incontinence. On February 23, nursing staff sent a message to the resident's provider reporting urinary odor, vaginal discharge, and increasing confusion and agitation.
Four hours later, the provider ordered Macrobid 100 mg twice daily for seven days to treat dysuria. The facility started the antibiotic without collecting a urine sample first.
Registered nurse RN-C told inspectors they "typically would obtain a urine specimen prior to starting an antibiotic but R13 had a history of refusals and had refused a urine sample." The nurse finally collected urine on February 25, the same day they received orders for urinalysis.
When lab results came back March 2, they revealed exactly what antibiotic stewardship protocols are designed to prevent. The resident had an extended-spectrum beta-lactamases infection — a multi-drug-resistant organism with more than 100,000 colony forming units per milliliter. The bacteria was resistant to cefuroxime and other standard treatments.
The facility's infection preventionist confirmed staff failed to follow proper procedures. During the inspection interview, they stated nurses needed to identify at least three symptoms like fever, cognitive changes, or urinary symptoms when suspecting a UTI. They also said facilities should complete tools like McGreer's criteria before requesting antibiotics.
"There was no documentation that this occurred prior to obtaining antibiotic orders for R13 on 2/23/26," the infection preventionist told inspectors.
McGreer's criteria provides specific clinical benchmarks for diagnosing infections in long-term care settings. It requires documented evidence of infection symptoms before antibiotic treatment begins, helping prevent the overuse that creates drug-resistant bacteria.
The facility's own policies supported these requirements. Director of nursing told inspectors that when UTI was suspected, staff should monitor symptoms, assess using McGreer's criteria, initiate standing orders for UTI testing and increased fluids, then update the provider. Nurses were expected to question providers ordering antibiotics before specimen collection and document those discussions.
None of this happened for R13.
The medical record contained no evidence that staff used McGreer's criteria or any established infection guidelines before the antibiotic was prescribed. There was no documentation of non-pharmaceutical interventions tried first, despite facility policies calling for increased fluids and other supportive measures.
The director of nursing told inspectors nurses should "question a provider ordering antibiotics prior to specimen collection, document the discussion, and report concerns to the DON or IP nurse." No such documentation existed in R13's file.
Federal antibiotic stewardship requirements exist because inappropriate antibiotic use creates cascading problems. The facility's own policy, dated April 2024, acknowledged that misuse "affects individual residents and the overall community with the potential for opportunistic infections, drug interactions, and drug-resistant pathogens."
R13's case demonstrated these exact risks. The resident received seven days of an antibiotic that proved ineffective against their actual infection. The delay in proper testing meant the multi-drug-resistant bacteria went unidentified for over a week while the resident continued experiencing symptoms.
The resident's increasing confusion and agitation — symptoms that prompted the antibiotic request — could have worsened during this period of inappropriate treatment. For someone with existing dementia and paraplegia, prolonged infection symptoms represent serious quality of life concerns.
By the time lab results revealed the resistant organism on March 2, the original antibiotic course had been completed and discontinued. The inspection report does not indicate what treatment, if any, the resident ultimately received for the confirmed infection.
The violation affected one resident but revealed systemic failures in the facility's antibiotic stewardship program, putting other residents at risk for similar inappropriate prescribing practices.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Sandstone Health Care Center from 2026-04-08 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
SANDSTONE HEALTH CARE CENTER in SANDSTONE, MN was cited for violations during a health inspection on April 8, 2026.
The resident had multiple sclerosis, diabetes, paraplegia and dementia, along with an indwelling catheter and urinary incontinence.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.