Failure to Follow Physician Orders for Medication Administration and Pain Management
Penalty
Summary
The facility failed to follow physician orders and established policies for two residents. For one resident with essential hypertension, the clinical record showed that Metoprolol Tartrate was ordered to be held if systolic blood pressure (SBP) was less than 130. However, the medication was administered eight times outside of these parameters over a three-month period, contrary to the physician's order. This was confirmed through review of the medication administration record (MAR) and conveyed to facility leadership. For another resident with diagnoses including malignant neoplasm of the tongue, tracheostomy, and dysphagia, physician orders specified an NPO (nothing by mouth) diet and that all medications be administered via PEG-tube. Despite this, the MAR documented that multiple medications, including Morphine, Risperdal, Amoxicillin, and Docusate, were administered by mouth. Additionally, Morphine, ordered for moderate to severe pain, was given when the resident's documented pain level was 0 to 2. Interviews with staff and the resident confirmed that all medications should have been given via PEG-tube and that the resident was NPO. Documentation errors were also acknowledged by the Director of Nursing.