Failure to Administer PRN Antihypertensive Medication as Ordered
Penalty
Summary
A deficiency was identified when nursing staff failed to administer a prescribed PRN antihypertensive medication, hydralazine, to a resident with a history of hypertension, transient ischemic attack, cerebral infarction, paroxysmal atrial fibrillation, aortic stenosis, atherosclerotic heart disease, and peripheral vascular disease. The physician's order specified that hydralazine 50 mg should be given by mouth every 8 hours as needed for systolic blood pressure (SBP) greater than 160. Multiple instances were documented where the resident's SBP exceeded 160, but the medication administration record (MAR) was left blank, and there was no documentation in the nursing progress notes indicating whether the medication was administered or if the blood pressure was rechecked. On several dates across three months, the resident's SBP readings were recorded as above the threshold for PRN hydralazine administration, yet there was no evidence in the MAR or nursing notes that the medication was given or that follow-up actions were taken. Interviews with nursing staff revealed inconsistent practices regarding rechecking blood pressure, documenting actions taken, and administering the PRN medication as ordered. Some nurses stated they may have rechecked the blood pressure or notified the oncoming nurse, but these actions were not documented. One nurse admitted she may have forgotten to sign the MAR after giving the medication, while another acknowledged the lack of prompts in the electronic system to alert staff to high blood pressure readings. The Director of Nursing confirmed that the PRN order for hydralazine was active and should have been followed when the resident's SBP was above 160. The resident's physician also stated that he expected the medication to be administered as prescribed and for staff to document reasons if it was not given. The physician noted that a systolic blood pressure of 195 could have serious health implications, and he would have advised administration of the PRN medication if contacted.