Failure to Follow Physician Orders for Medication Administration Parameters
Penalty
Summary
The facility failed to provide nursing services consistent with professional standards of quality by not ensuring that licensed nurses evaluated and provided nursing care according to physician orders for a resident with hypertension and atrial fibrillation. The resident, who was severely cognitively impaired, had a physician's order for Metoprolol to be administered twice daily with specific parameters to hold the medication if the systolic blood pressure was less than 100 mm Hg or the heart rate was less than 60 beats per minute. However, a review of the Medication Administration Records (MAR) for May and June revealed no evidence that the resident's blood pressure or heart rate was monitored prior to administering the antihypertensive medication as required by the order. Additionally, in July, the MAR showed that Metoprolol was held on two occasions due to 'parameters,' even though the resident's blood pressure and heart rate were above the hold thresholds specified in the physician's order. These findings were confirmed by facility leadership, who acknowledged that the physician's orders were not followed as written. The deficiency was identified through clinical record review, facility policy review, and staff interviews.