Failure to Follow Physician Orders and Document Medication Administration
Penalty
Summary
Nursing staff failed to follow physician orders regarding the administration of a cardiovascular medication for a resident who was totally dependent on staff for care, ventilator dependent, had a tracheostomy, and received nutrition and hydration via a feeding tube. The physician's order specified that Propranolol Hydrochloride, 10 mg, should be administered every 8 hours by mouth for tachycardia, but to hold the medication if the resident's heart rate was less than 100 beats per minute. However, review of the medication administration records for September and October showed that staff documented administration of the medication without recording the resident's heart rate or confirming whether the heart rate was below the threshold specified in the order. Additionally, the nursing staff did not accurately document the route of administration for the medication. Although the resident was receiving nutrition and hydration through a gastrostomy tube, the medical record continued to indicate that the medication was being given by mouth, rather than through the feeding tube. The Director of Nursing was unaware of these documentation and administration errors until the time of the survey.