Failure to Monitor Blood Pressure and Timely Collect Urine Specimen
Penalty
Summary
The facility failed to provide appropriate care and treatment according to physician orders and professional standards for two residents. For one male resident with a history of Alzheimer's Disease, stroke, and hypertension, the facility did not consistently monitor and document blood pressure readings as required. Despite being prescribed multiple antihypertensive medications, including one to be administered as needed for elevated systolic blood pressure, nursing staff did not check or record blood pressure at least once daily on 25 occasions over a two-month period. The resident's care plan did not include a cardiovascular/hypertension focus until the day the survey began, and the as-needed medication was never administered, with no documentation to support whether it was needed or not. Interviews with nursing staff, including LPNs, RNs, the Unit Manager, and the DON, revealed a consistent expectation that blood pressure should be checked and documented prior to administering antihypertensive medications. However, the medical record review showed this was not done, and the DON acknowledged the missing entries and the delayed addition of the care plan. Facility guidelines required nurses to obtain and record vital signs prior to medication administration, but this standard was not met for the resident in question. For another resident with diagnoses including muscle wasting, pneumonia, diabetes, and kidney failure, the facility failed to implement a physician's order for a urinalysis with culture and sensitivity in a timely manner. The resident and her son reported symptoms of a urinary tract infection and communicated these to staff, but the urine sample was not collected for over 24 hours after the order was placed. There was no documentation in the medical record explaining the delay, and communication among staff was inconsistent, with some CNAs unaware of the need for specimen collection. The DON confirmed there was no facility policy specifying a 48-hour window for specimen collection and stated that standard practice was to collect samples as soon as possible.