Failure to Administer Ordered Medication for Hypotension
Penalty
Summary
A deficiency occurred when a resident with a history of cervical spinal cord injury, quadriplegia, hypotension, autonomic nervous system disorder, muscle weakness, and depression did not receive Midodrine HCL as ordered by the physician on multiple occasions. The medication, prescribed to manage low blood pressure, was scheduled to be administered via G-tube every 8 hours and held only if the resident's systolic blood pressure (SBP) was greater than 140. On three separate dates, the medication was not given when the resident's SBP was exactly 140, which did not meet the physician's criteria for holding the medication. The Medication Administration Record (MAR) documented that the medication was held due to being 'outside of parameter,' and the code used indicated 'No Med Required.' Interviews with facility staff revealed that the expectation was to administer the medication unless the SBP exceeded 140, and that the nurse should have notified the physician and documented the reason if the medication was held. The resident and responsible party confirmed that the medication was not administered as scheduled, and that a different nurse, not the primary charge nurse, was involved in medication administration on at least one occasion. The facility's policy required medications to be administered as prescribed, but this was not followed, resulting in the resident not receiving the ordered treatment for hypotension.