Failure to Hold Antihypertensive Medications per Physician Parameters
Penalty
Summary
A deficiency occurred when a resident with a history of multiple sclerosis, cognitive communication deficit, essential hypertension, and a history of transient ischemic attack was administered Lisinopril and Metoprolol despite physician orders specifying to hold these medications if the resident's systolic blood pressure (SBP) was less than 110, diastolic blood pressure (DBP) was less than 60, or heart rate (HR) was less than 60. On four separate occasions, nursing staff administered both medications even though the resident's SBP and/or DBP were below the ordered parameters. Specifically, the medications were given when the SBP was recorded as 106, 104, and 98, and the DBP was as low as 59, all of which were outside the prescribed limits. The medication administration records confirmed that the medications were marked as given on these dates by two different nurses, both of whom no longer worked at the facility at the time of the survey. There was no documentation of adverse effects in the resident's progress notes. Interviews with the DON and Administrator confirmed that the medications should not have been administered outside the physician's parameters and that all physician orders are expected to be followed. The facility's medication administration policy also required adherence to specific monitoring and the 10 rights of medication administration.