Antihypertensive Medication Held Outside Physician Order Without Notification
Penalty
Summary
A deficiency occurred when a nurse failed to administer an antihypertensive medication, losartan-hctz, to a resident in accordance with the physician's order. The physician's order specified that the medication should be held only if the resident's systolic blood pressure (SBP) was less than 110 or pulse was less than 60. On the date in question, the resident's SBP was 119, which was above the hold threshold, but the nurse held the medication based on her own judgment, citing concern that the blood pressure was 'low.' There was no documentation that the resident's physician was notified about the medication being held outside of the ordered parameters. The Director of Nursing confirmed that the nurse did not follow the physician's order and that there was no progress note or physician notification regarding the held dose. The facility did not have a specific policy on holding blood pressure medications, but the expectation was that nurses would follow physician orders and document any deviations.