Failure to Follow Physician's Order for Apical Pulse Prior to Heart Medication Administration
Penalty
Summary
A licensed vocational nurse (LVN) failed to follow a physician's order requiring the measurement of a resident's apical pulse prior to administering Flecainide, a heart medication. The resident, who had a diagnosis of atrial fibrillation and was cognitively intact, had a physician's order specifying that Flecainide should be held if the apical pulse was less than 60 beats per minute. Despite this, the LVN did not take the apical pulse before administering the medication on multiple occasions, as evidenced by the Medication Administration Records (MAR) for March, April, and May, which showed no documentation of the apical pulse being taken prior to administration. During a medication pass observation, the LVN was seen taking only the resident's blood pressure and radial pulse before giving Flecainide, and stated there was no need to check anything else. When questioned, the LVN indicated he was unaware of the order to check the apical pulse and had never done so for this resident before administering the medication. The LVN also stated that the electronic medical record system did not prompt for an apical pulse entry, and believed that the order should have been entered with a parameter requiring this check. The Director of Nursing (DON) and the facility's Pharmacist Consultant both confirmed that the apical pulse should have been checked and documented prior to each administration of Flecainide, as per the physician's order and pharmacy recommendations. The DON verified that the medication was given without the required apical pulse check on multiple occasions. The LVN's competency records indicated training on following medication parameters, but this was not adhered to in practice. The facility's policy required medications to be administered according to physician orders, which was not followed in this instance.