Failure to Accurately Monitor Orthostatic Hypotension
Penalty
Summary
The facility failed to ensure accurate monitoring of orthostatic hypotension for one resident. According to the facility's policy, orthostatic vital signs are to be taken and recorded when ordered by a physician and when symptoms such as falls, vertigo, or dizziness occur. The policy defines orthostatic hypotension as a 20 mmHg drop in systolic or a 10 mmHg drop in diastolic blood pressure within three minutes of standing, with even smaller drops being significant in elderly individuals. For this resident, physician orders required weekly monitoring of orthostatic blood pressure in both lying and sitting positions on Saturdays due to the use of hypertension medications. Medical record review showed that on two separate dates, the blood pressure readings recorded for both lying and sitting positions were identical. During interviews, both the LVN and the DON acknowledged that these identical readings were not accurate and that blood pressure values should fluctuate between positions. The failure to accurately monitor and record orthostatic blood pressure could have impacted the adjustment of the resident's hypertension medications as needed.