Failure to Withhold Antihypertensive Medication per Physician Parameters
Penalty
Summary
A deficiency occurred when a resident with diagnoses including diabetes mellitus and atrial fibrillation did not receive medication administration in accordance with physician orders and professional standards. The resident, who was moderately cognitively impaired and required substantial assistance with activities of daily living, had a physician order for Carvedilol to be administered twice daily via G-tube for hypertension, with specific instructions to hold the medication if the systolic blood pressure was less than 110 or if the heart rate was less than 60 beats per minute. Despite these clear parameters, the medication administration record showed that Carvedilol was given on multiple occasions when the resident's heart rate was below 60 and when the systolic blood pressure was below 110. Interviews and record reviews confirmed that the licensed nurse did not follow the physician's hold parameters for Carvedilol. The facility's policy on administering medications required that vital signs be obtained prior to administration when necessary, which was not adhered to in this case. The failure to withhold the medication as ordered was acknowledged by facility staff during interviews.