Failure to Obtain Required Vital Signs Prior to Medication Administration
Penalty
Summary
The facility failed to provide pharmaceutical services in accordance with professional standards by not ensuring that an apical pulse was obtained before administering Digoxin to a resident. An LPN was observed preparing to administer Digoxin and stated awareness of the need for an apical pulse, but instead took a radial pulse by holding the resident's wrist for 60 seconds. The LPN acknowledged not having a stethoscope and confirmed that the correct procedure was to use a stethoscope to obtain an apical pulse for Digoxin administration. The Director of Nursing, Unit Manager, and Consultant Pharmacist all confirmed that the standard practice is to obtain an apical pulse with a stethoscope for 60 seconds before giving Digoxin, and the physician's order for the resident specified to hold Digoxin if the apical pulse was 60 or below. Additionally, the facility did not ensure that required vital sign parameters for medication administration were obtained in a timely manner. Another LPN was observed administering Doxazosin to a resident based on a blood pressure reading taken over two hours earlier during morning rounds, rather than immediately before medication administration as required by facility policy and professional standards. The LPN stated that it was her routine to use blood pressure readings from earlier in the shift for medication passes, and the Unit Manager confirmed that this was a common practice unless the earlier reading was low. The Consultant Pharmacist and Director of Nursing both indicated that blood pressure should be taken within an hour, and ideally just before administering medications with hold parameters. Review of inservice education materials showed that staff had been instructed to take vital signs such as apical pulse and blood pressure immediately before pouring medications with specific hold parameters. However, one LPN involved in the Digoxin incident had not attended the relevant inservice, while the LPN involved in the Doxazosin incident had attended. The facility's failure to ensure adherence to these standards resulted in the deficient practices observed during the survey.