Failure to Hold Cardiac Medications per Physician Orders
Penalty
Summary
The facility failed to follow physician orders and professional standards of care for medication management in three out of five residents reviewed. Specifically, nursing staff administered cardiac medications, including Amlodipine and Metoprolol, to residents despite physician orders to hold these medications if certain blood pressure (BP) or heart rate (HR) parameters were not met. For example, one resident with a history of atherosclerosis, prosthetic heart valve, hypertension, and hyperlipidemia received these medications on multiple occasions when their HR or diastolic BP was below the ordered threshold. Another resident with congestive heart failure, atherosclerotic heart disease, and a cardiac pacemaker was given Amlodipine when their systolic BP was below the ordered limit. A third resident with hypertension also received Amlodipine when their BP or HR was below the specified parameters. Interviews with nursing staff confirmed that they were aware of the need to check vital signs and hold medications per parameters, yet the medication administration records (MARs) showed repeated instances where medications were given despite abnormal vital signs. The administrator also confirmed the expectation that medications should be held according to the parameters set by the physician orders. These findings were based on record reviews and staff interviews, and reference was made to WAC: 388-97-1060 (1).