Failure to Follow Physician Orders for Cardiac Medication Hold Parameters
Penalty
Summary
The facility failed to follow physician's orders regarding hold parameters for cardiac medications for three residents. For one resident with a history of stroke, hypertension, and coronary artery disease, the physician's order specified that Midodrine should be held if the systolic blood pressure exceeded 120. However, the medication was administered multiple times when the resident's systolic blood pressure was above this threshold, as documented in the Electronic Medication Administration Record (EMAR). Another resident, diagnosed with diabetes, hypertension, neurogenic bladder, and aphasia, had a physician's order for Losartan to be held if the systolic blood pressure was less than 120 or the heart rate was less than 60. Despite this, the EMAR showed that the medication was given on several occasions when the resident's systolic blood pressure was below 120. This pattern was observed over several months, indicating a repeated failure to adhere to the specified hold parameters. A third resident, with multiple diagnoses including amputation, anemia, hypertension, and diabetes, also had a physician's order for Midodrine to be held if the systolic blood pressure was greater than 120. The EMAR revealed that the medication was administered on numerous occasions when the resident's systolic blood pressure exceeded the prescribed limit. During an interview, an LPN stated that medications with hold parameters should not be administered if vital signs are outside the specified range, and the facility's policy confirmed this requirement. Despite this, the records demonstrated that staff did not consistently follow these orders.