Failure to Follow Physician Orders for Medication and Pacemaker Care
Penalty
Summary
The facility failed to provide care in accordance with physician orders and professional standards for two residents. For one resident with a history of hypertension and paroxysmal atrial fibrillation, the care plan required administration of Metoprolol Succinate ER as ordered by the physician, with specific parameters to hold the medication if the systolic blood pressure was less than or equal to 110 or the heart rate was less than or equal to 70. Despite these parameters, the medication was administered multiple times when the resident's pulse was below or at the threshold, and there was no documentation explaining why the medication was given outside of the prescribed parameters. The Director of Nursing confirmed that there was no documented evidence to justify these actions. For another resident, clinical records indicated the presence of a cardiac pacemaker, as noted on a chest x-ray ordered due to tachycardia and fever. The resident's care plan included an intervention to monitor pacemaker checks, but there were no physician orders in place for such monitoring. The Director of Nursing was initially unaware of the resident's pacemaker and later confirmed that no orders for pacemaker checks existed. These findings demonstrate a failure to provide the highest practicable care regarding both medication administration and pacemaker management.
Plan Of Correction
The facility verified the need for resident #384's order for pacemaker checks and obtained an order for such actions to be performed, and the care plan was updated. Resident #43's MAR was reviewed, and again no documented evidence as to why this was occurring could be found. It was reiterated to clinical staff that if no specific order exists, and the medication will be administered in accordance with the physician specified parameters. No ill effect is evident for either resident #43 or resident #384. A review of resident charts was conducted by nursing staff for any potential medication being given outside the parameters of order as given by the provider. Any noted infractions were discussed with the provider and corrected. Residents with pacemakers and pacemaker care plans were reviewed for appropriate provider orders to monitor pacemaker checks. Corrective actions were taken on any identified resident charts affected by this review. Education was provided to licensed staff on the facility's policy and procedures on the correct monitoring and adherence to residents with pacemakers and medication administration. Audits on five medical charts will be conducted to ensure compliance with appropriate assessments from identified findings weekly for one month and bi-weekly for three months. Findings will be presented to the Quality Assurance Performance Improvement committee for recommendations, an explanation of any identified variance infractions.