Failure to Accurately Administer and Document Medications with Parameters
Penalty
Summary
The facility failed to provide pharmaceutical services that ensured the accurate administration of medications as ordered by physicians for two residents. For one resident with multiple diagnoses including hypertension, muscle weakness, and severe cognitive impairment, the prescribed blood pressure medication, metoprolol, was not documented as held when the resident's blood pressure was below the physician-ordered parameters. There was no documentation in the nurse's progress notes explaining why the medication was not held, and the responsible RN acknowledged that the medication should have been held and properly documented on the MAR and in the nurse's notes. Another resident, with diagnoses such as essential hypertension, heart failure, and cognitive awareness, had physician orders for both midodrine and metoprolol with specific blood pressure parameters for administration. The MAR indicated that midodrine was not held on several occasions when the resident's systolic blood pressure exceeded the ordered threshold, and metoprolol was not held when the blood pressure was below the required parameters. There was no documentation in the nurse's notes to explain why these medications were administered or not held as per the orders. The RN involved admitted to documenting in error and not following the required procedure for medications with parameters. Interviews with nursing staff and the DON confirmed that medications with parameters must be administered according to the physician's orders and that any medication held or not given should be clearly documented with the reason. The facility's policy also requires that withheld medications be properly documented on the MAR. The lack of adherence to these procedures resulted in the failure to ensure accurate medication administration and documentation for the residents involved.