Failure to Follow Physician Orders for Medication Administration
Penalty
Summary
Licensed Practical Nurses (LPN) A and B failed to follow physician orders regarding the administration of Metoprolol Tartrate for a resident with diagnoses including Paroxysmal Atrial Fibrillation, Major Depressive Disorder, Hypertension, and Cerebrovascular Disease. The physician's order specified that Metoprolol Tartrate 12.5 mg should be administered twice daily by mouth, but to hold the medication if the resident's heart rate was less than 60 beats per minute (bpm). Despite this clear instruction, medical record review showed that the medication was administered on multiple occasions when the resident's heart rate was below 60 bpm, with documented heart rates of 59, 58, 52, and 56 bpm by LPN A, and 58 bpm by LPN B. Facility policy required medications to be administered as prescribed by the attending physician and in accordance with written orders. The Medication Administration Record (MAR) confirmed that the medication was given contrary to these orders. Interviews with the Director of Nursing (DON) and LPN A confirmed that staff are expected to follow physician orders and that LPN A had administered the medication despite the resident's heart rate being below the specified threshold on several occasions.