Failure to Follow Physician Orders for Medication Administration
Penalty
Summary
The facility failed to follow physician's orders for medication administration for three residents. One resident, who was cognitively impaired and required extensive assistance, had physician's orders for Senna and Bisacodyl to be administered as needed for constipation if no bowel movement occurred within a specified number of days. Review of records showed that the resident went up to seven days without a bowel movement, and staff did not administer the prescribed medications until the sixth day, contrary to the physician's orders. The Director of Nursing confirmed that the medications were not given as ordered. Another resident, also cognitively impaired and diagnosed with hypertension, had an order for Propranolol with instructions to hold the medication if the heart rate was below 60 or systolic blood pressure was below 100. Staff failed to assess and document the resident's heart rate and blood pressure prior to administration. A third resident, who was cognitively intact and had renal insufficiency requiring dialysis, had an order for Midodrine to be held if systolic blood pressure exceeded 130. Despite this, the medication was administered multiple times when the resident's systolic blood pressure was above the threshold. The Director of Nursing confirmed that the medication should have been held on those occasions.