Failure to Notify Physician of Missed Medication Doses and Abnormal Heart Rate
Penalty
Summary
The facility failed to notify the physician when a resident missed prescribed doses of an antibiotic and experienced an abnormal heart rate. Specifically, a resident with diagnoses including congestive heart failure and atrial fibrillation had physician orders for metoprolol succinate and ciprofloxacin hydrochloride. The medication administration record showed missed doses of ciprofloxacin on three occasions and missed doses of metoprolol on two occasions. There was no documentation that the physician was notified of the missed antibiotic doses. Additionally, the same resident received metoprolol with a recorded heart rate of 120 bpm, but there was no documentation that the physician was notified of this elevated heart rate. Interviews with staff confirmed the lack of physician notification for both the missed antibiotic doses and the elevated heart rate. The DON stated that the physician should be notified of missed antibiotic doses and that the physician's preference for notification of elevated heart rate was communicated verbally to staff.