Failure to Follow Physician Orders for Heart and Breathing Medications
Penalty
Summary
The facility failed to implement physician's orders for both a heart medication and a breathing medication for one resident. During medication administration, a registered nurse identified that the resident's apical pulse was 45 beats per minute, which was below the threshold of 60 as specified in the physician's order for the heart medication. The order required the medication to be held and the physician to be notified if the pulse was below 60, but there was no documentation that the physician was notified on multiple occasions when the resident's pulse was below the specified threshold, as evidenced by the Medication Administration Records for April and May. Additionally, the same resident was observed receiving a breathing medication via inhaler, with physician's orders to rinse the mouth with water and spit it out after administration. The nurse administering the medication did not have the resident rinse their mouth as ordered. The Director of Nursing Services confirmed that the expectation was to follow physician's orders and acknowledged that there was no documentation of physician notification when the resident's pulse was below 60.