Failure to Follow Physician Orders for Medication Administration and Medical Devices
Penalty
Summary
Staff failed to follow physician orders for two residents, resulting in improper medication administration and lack of required medical devices. For one resident with hypertension, staff administered multiple blood pressure medications outside of the prescribed parameters, including giving hydralazine hydrochloride when the systolic blood pressure (SBP) was below 100 mmHg, and administering amlodipine besylate and lisinopril when the SBP was below 110 mmHg. Additionally, metoprolol was given when the resident's heart rate was less than 60, contrary to the physician's instructions. There were also instances where there was no documentation that scheduled medications were offered as required. The Director of Nursing confirmed that these medications were administered outside of the established parameters and that documentation was lacking. For another resident with a history of traumatic brain injury and left elbow contracture, staff did not ensure that a left palm guard with finger separators was in place at all times as ordered by the physician. The clinical record and direct observation showed that the palm guard was not in place on certain days, and when it was in place, the finger separators were missing, resulting in the resident's fingers being contracted and overlapping. The Administrator confirmed that the finger separators should have been in place according to the physician's order.