Failure to Monitor Medication Parameters and Side Effects
Penalty
Summary
The facility failed to monitor the effectiveness and side effects of antihypertensive and pain medications as ordered by the physician for a resident with multiple diagnoses, including slow transit constipation, pain, dementia, and hypertension. Physician orders required that the resident's pulse be checked before administering metoprolol, with instructions to hold the medication and notify the nurse if the pulse was below 60 BPM or systolic blood pressure was below 110 mmHg. However, medication administration records and treatment records lacked documentation of the resident's pulse as required by the physician's order. Both a certified medication aide and a licensed nurse confirmed that the resident's record did not include the necessary pulse documentation, and the facility did not provide a policy addressing the administration of medication outside prescribed parameters or monitoring for side effects. Additionally, the resident was prescribed tramadol for pain, which is associated with a black box warning and known to cause constipation. The resident's care plan directed staff to monitor for adverse reactions, including constipation, and to follow a bowel protocol if the resident had not had a bowel movement for three days. Despite this, the resident's records showed multiple periods of three or more days without a documented bowel movement, and there was no evidence that the facility assessed for complications of constipation during these times. Staff interviews revealed that while a bowel protocol existed and reports were generated to flag residents without bowel movements, there was a lack of awareness and follow-through regarding this resident's constipation. The consultant pharmacist's monthly medication regimen reviews did not identify or report the lack of pulse monitoring as required by the physician's order. The facility's standing orders included a protocol for treating constipation, but there was no documentation that this protocol was initiated for the resident during the periods of constipation. The facility did not provide a policy to address the administration of medication outside of prescribed parameters or to ensure monitoring for side effects or adverse effects for residents taking medications.