Failure to Monitor BP for PRN Antihypertensive and Ensure Medication Availability
Penalty
Summary
The facility failed to ensure proper pharmaceutical services for its residents in two key areas. For one resident with hypertension and severe cognitive impairment, there was a physician's order for clonidine to be administered as needed based on systolic blood pressure (SBP) greater than 160. However, blood pressure monitoring was not performed or documented three times daily as required over several months, making it unclear whether the medication was administered appropriately according to the physician's parameters. Both the Certified Medication Aide (CMA) and the Director of Nursing (DON) confirmed that blood pressure should be checked every shift, but were unable to provide documentation of these checks in the electronic medical record. Another resident with multiple diagnoses, including psychosis, thyroid disorder, and atrial fibrillation, experienced multiple instances where prescribed medications were unavailable for administration. The medication administration records showed that Rexulti, levothyroxine, metoprolol, and midodrine were not available on several occasions, resulting in missed doses. The CMA explained that medications are reordered when supplies run low, but acknowledged that some medications were out of stock and that a prescription had to be resent to the pharmacy. These failures indicate that the facility did not ensure medications were consistently available and administered as ordered.