Failure to Follow Physician-Ordered Parameters for Blood Pressure Medications
Penalty
Summary
The facility failed to administer blood pressure medications according to physician-ordered parameters for a resident with multiple cardiovascular diagnoses, including heart failure and hypertension. The resident had specific orders for Amlodipine Besylate and Lisinopril, both with instructions to hold the medication if systolic blood pressure was below 110 mmHg, diastolic blood pressure was below 60 mmHg, or heart rate was less than 60 bpm. Over a 59-day period, documentation showed that four nurses administered these medications outside of the specified parameters on several occasions, and one nurse gave the medications without considering the parameters at all. The Medication Administration Record (MAR) indicated that the resident received blood pressure medications on multiple days when blood pressure or heart rate readings were below the ordered thresholds or not documented at all. Review of the resident's progress notes for the relevant period revealed no documentation explaining why the medications were administered outside of the physician's parameters. During interviews, a registered nurse acknowledged administering the medications outside of the parameters and was unable to provide documentation of rechecked blood pressure readings. The Director of Nursing also confirmed that the medications were given outside of the physician's orders and stated that staff are expected to follow such parameters.