Medication Administered Outside Physician-Ordered Parameters
Penalty
Summary
A deficiency was identified when a resident with multiple diagnoses, including hypertensive heart disease, paroxysmal atrial fibrillation, atherosclerotic heart disease, malignant neoplasm of the scrotum and prepuce, and pleural effusion, received medication outside of physician-ordered parameters. The resident had an order for midodrine HCL 5 mg three times daily, with instructions to hold the medication if the systolic blood pressure was greater than 120 mm Hg. Despite this, the medication was administered on three separate occasions when the resident's systolic blood pressure readings were above the specified threshold (137/78, 137/74, and 138/74 mm Hg), as documented in the June Medication Administration Record. Interviews with the registered nurse who administered the medication and the Director of Nursing revealed that neither could provide an explanation for why the medication was given outside the ordered parameters. A nurse practitioner acknowledged that while administration outside parameters might be acceptable on dialysis days in some cases, it could still pose issues depending on the resident's overall condition. The report notes that there were no adverse consequences from these incidents, but the administration of medication was not in accordance with the physician's orders.