Failure to Monitor and Care Plan for High-Risk Medications
Penalty
Summary
The facility failed to ensure that three residents were free from unnecessary drugs due to a lack of monitoring and care planning for high-risk medications. For one resident with a history of aortic valve stenosis and atrial fibrillation, there was no care plan addressing the use of Eliquis (an anti-coagulant), and no interventions or monitoring for signs and symptoms of bleeding or bruising were developed, despite the resident receiving the medication twice daily. Similarly, another resident with recent cardiac surgery was administered Apixaban without a care plan or monitoring for side effects, even though the resident had a history of bleeding issues and was later observed with blood in the catheter bag, leading to hospitalization after continued bleeding and low blood pressure. Additionally, a third resident with vascular wounds and lower extremity edema was prescribed Lasix and elastic stockings for edema management, but there was no monitoring for edema or side effects of the diuretic therapy documented in the medical record. Observations confirmed the resident continued to experience swelling and had a history of sores on the legs, yet no monitoring was in place. Interviews with staff confirmed that monitoring for anti-coagulants and diuretics was not included in the care plans or medication orders for these residents. Staff acknowledged that the electronic medical record system did not prompt for side effect monitoring for these high-risk medications, and that such monitoring should have been included in the baseline care plans for new admissions receiving these drugs.