Failure to Follow Physician-Ordered Parameters for Blood Pressure Medication
Penalty
Summary
The facility failed to administer blood pressure medication according to physician-ordered parameters for one resident with a diagnosis of hypertension, heart valve insufficiency, and hyperlipidemia. The resident had a physician order for Metoprolol Tartrate 12.5 mg twice daily, with specific instructions to hold the medication if the resident's heart rate was less than 55 beats per minute or if the systolic blood pressure (SBP) was less than 120. Review of the Medication Administration Record (MAR) for two months showed that nine nurses administered Metoprolol outside of these parameters on ten occasions, with the medication being given on days when the resident's SBP was below the ordered threshold. There was no documentation in the progress notes to explain why the medication was administered outside of the prescribed parameters on these dates. Interviews with nursing staff confirmed that Metoprolol was given in error when the resident's SBP was below the specified limit, and staff acknowledged that the medication should have been held according to the physician's order. The Director of Nursing also verified that the medication was not held as required and stated that nurses are expected to follow physician orders. The facility's policy on administering medication requires that medications be given in accordance with prescriber orders, including checking and verifying vital signs when necessary.