Failure to Follow Physician Orders for Medication and Fluid Restriction
Penalty
Summary
The facility failed to follow physician orders for three residents, resulting in deficiencies related to medication administration and fluid restriction. For one resident with hypotension, Midodrine was administered multiple times despite blood pressure readings exceeding the physician-ordered threshold for withholding the medication. Documentation showed that the medication was given on several occasions when the systolic blood pressure was above 125 mm/Hg, contrary to the order. Another resident with acute congestive heart failure and malnutrition had a physician order for a strict fluid restriction, but records indicated that the resident consistently received fluids in excess of the prescribed daily limit over several days. Additionally, a third resident with hypertensive chronic kidney disease received Metoprolol Succinate ER outside of the specified blood pressure and heart rate parameters on four occasions. These findings were confirmed through review of clinical records, medication administration records, and staff interviews.