Failure to Check Vital Signs Before Administering Antihypertensive Medications
Penalty
Summary
A Licensed Vocational Nurse (LVN) administered Bumetanide, Carvedilol, and Losartan to a resident without checking the resident's vital signs prior to medication administration. The resident had a history of essential primary hypertension, congestive heart failure, and a cardiac pacemaker. The nurse relied on vital signs taken earlier in the morning by a Certified Nursing Assistant and did not verify their accuracy or obtain a recent blood pressure reading, despite physician orders specifying parameters for holding antihypertensive medications based on current systolic blood pressure and heart rate. The Director of Nursing confirmed that the medications were not administered in a safe manner, as the LVN did not follow the required parameters or check the resident's vital signs before giving the medications. The resident's care plan and the facility's medication administration policy both required adherence to these parameters and verification of vital signs prior to administration. The failure to check vital signs before administering these medications constituted a significant medication error.