Failure to Check Apical Pulse Before Administering Heart Medication
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to check a resident's apical pulse prior to administering Flecainide, a heart medication, as required by the physician's order. The resident, who had a diagnosis of atrial fibrillation and was cognitively intact, had a specific order to hold the medication if the apical pulse was less than 60 beats per minute. Despite this, the LVN administered the medication without taking the apical pulse, relying only on the radial pulse and blood pressure measurements. Review of the Medication Administration Records (MAR) for three consecutive months showed that the apical pulse was not taken before administering Flecainide on multiple occasions. The MARs for March, April, and May indicated repeated failures to document the apical pulse prior to medication administration, confirming that this was an ongoing issue rather than an isolated incident. The resident's care plan also specified the need to assess and monitor vital signs as ordered, which was not followed in practice. Interviews with the LVN and the Director of Nursing (DON) revealed that the LVN was unaware of the requirement to check the apical pulse and that the electronic medical record system did not prompt for this parameter. The facility's policy required medications to be administered according to physician orders, but this was not adhered to in the case of this resident. The facility pharmacist had also recommended that the apical pulse be checked before administering Flecainide, but this recommendation was not implemented prior to the survey.