Failure to Follow Physician Orders for Blood Pressure Monitoring and Medication Administration
Penalty
Summary
The facility failed to ensure that residents' drug regimens were free from unnecessary medications by not following physician orders related to blood pressure monitoring and medication administration parameters for three residents. For one resident with Alzheimer's disease and hypertension, the medication Cozaar was administered outside of the prescribed blood pressure parameters on 45 out of 54 occasions. The care plan required staff to hold the medication if the blood pressure was below a certain threshold and notify the physician, but this was not consistently done. Staff confirmed that the medication should have been held and the physician notified when the resident's blood pressure was outside the specified range. Another resident with diagnoses including agoraphobia, anxiety, and hypertension was prescribed Norvasc with instructions to hold the medication if the systolic blood pressure was below a certain value. However, blood pressure was not obtained prior to administration of the medication on 74 occasions. Staff administering the medication did not monitor blood pressure as required by the physician's order, and this omission was confirmed by administrative nursing staff upon review of the medication administration records. A third resident with diabetes, end-stage renal disease, and hypertension was prescribed Procardia with instructions to contact the physician if blood pressure exceeded a certain value. There was no evidence that blood pressure was checked prior to administration of the medication, and staff reported that they did not routinely check blood pressure unless prompted by the electronic medication administration record. Nursing staff acknowledged that the required monitoring was not in place and that the physician's parameters should have been included in the documentation to alert staff. Facility policy required that each resident's drug regimen be free of unnecessary drugs, including those used in excessive doses or without proper monitoring.