Failure to Follow Physician Orders for Medication Administration and Monitoring
Penalty
Summary
The facility failed to ensure that physician orders regarding medication administration and monitoring were followed for two residents. For one resident with diagnoses of congestive heart failure and diabetes mellitus, the physician had ordered blood glucose monitoring four times daily, with instructions to notify the physician if blood sugar levels were less than 30 or greater than 350. Over a 94-day period, this resident's blood sugar was outside the ordered parameters on twelve occasions, but there was no documentation that the physician was notified as required. Both nursing staff and administrative staff confirmed that physician notification and documentation were expected when blood sugars were outside the specified range. The facility was unable to provide a policy related to following physician orders. For another resident with chronic respiratory failure, hypoxia, hypertension, and muscular dystrophy, the physician ordered Metoprolol to be administered twice daily for hypertension, with instructions to hold the medication if systolic blood pressure was less than 110 mmHg. Review of the medication administration record showed that Metoprolol was given outside the ordered parameters on ten occasions, with no documentation explaining why the medication was administered despite the blood pressure being below the threshold. Nursing and administrative staff confirmed that medication parameters should be followed and that any deviations should be documented, including the reason for administering medication outside of parameters if instructed by the physician. The facility's medication monitoring policy indicated that medications should be given per physician orders and that irregular medication findings should be reported and corrected. However, the observed practices for these two residents did not align with the policy or physician instructions, as required notifications and documentation were not completed.