Failure to Follow Physician Orders for Blood Pressure and Heart Rate Parameters
Penalty
Summary
The facility failed to ensure that physician orders for blood pressure (BP) and heart rate (HR) parameters were followed when administering antihypertensive medications for two residents. For one resident with diagnoses including hypertension, heart failure, and coronary artery disease, physician orders specified holding certain medications if BP or HR fell below set thresholds. Despite these orders, the medication administration records showed that medications such as metoprolol, amlodipine, and losartan were administered on multiple occasions when the resident's BP or HR were below the ordered parameters. The resident's care plans also directed staff to give medications as ordered and monitor for side effects, but these instructions were not consistently followed as evidenced by the documented administration outside of parameters. For another resident with a history of heart disease and hypertension, physician orders required administration of midodrine for systolic BP less than 90. However, the medication administration records indicated that on several occasions when the resident's BP was below this threshold, there was no documentation that midodrine was administered as ordered. The care plan for this resident also included monitoring BP and administering medications for hypertension as ordered, but the records did not reflect compliance with these directives. Interviews with nursing staff and the Director of Nursing confirmed that staff were expected to follow medication parameters and contact providers if there were questions or discrepancies. Despite this, the records demonstrated that medications were either administered when parameters were not met or not administered when indicated, contrary to physician orders. The facility did not have a specific policy on following physician orders, relying instead on federal and state guidelines.