Failure to Follow Physician-Ordered Parameters for Hypertension Medications
Penalty
Summary
The facility failed to ensure that physician-ordered parameters for administering hypertension medications were followed for three residents reviewed for medication management. For one resident with diagnoses including congestive heart failure, ischemic cardiomyopathy, COPD, and pneumonia, Metoprolol Tartrate was ordered to be held if systolic blood pressure (SBP) was less than 110 or heart rate less than 60. Despite this, the medication was administered multiple times when the resident's SBP was below the specified threshold, as documented in the Medication Administration Record (MAR) for June and July. Staff interviews confirmed that the medication was given outside of the ordered parameters and that the physician was not notified as required. Another resident with a history of cerebral infarction, myocardial infarction, bacteremia, and endocarditis had orders for Nifedipine and Metoprolol Tartrate to be held for SBP less than 120. The MAR showed that both medications were administered on several occasions when the resident's SBP was below the ordered parameter. Staff interviews revealed that the nurses were aware of the parameters but did not withhold the medication or contact the physician, and there was no documentation of physician notification. A third resident with muscle weakness, anxiety disorder, depression, dementia, and hypertension had an order for Metoprolol Succinate to be held for SBP less than 120. The MAR indicated that the medication was administered when the resident's SBP was below the specified parameter. Staff interviews indicated confusion about the medication administration system and the meaning of checkmarks, as well as uncertainty about whether the correct procedures were followed. The DON confirmed that the system does not auto-populate blood pressures and that staff are responsible for entering and following the parameters as ordered.