Failure to Monitor Blood Pressure as Ordered for Antihypertensive Medications
Penalty
Summary
A deficiency was identified when a resident's drug regimen was not kept free from unnecessary drugs due to a failure to monitor blood pressure as required by physician orders. The resident, admitted for rehabilitation with diagnoses including paralytic syndrome following cerebral infarction, hypertension, and other conditions, was prescribed three blood pressure medications: Isosorbide Mononitrate, Lisinopril, and Hydralazine. All three medications had physician-ordered parameters to hold administration if the blood pressure reading was less than 100. While the Medication Administration Record (MAR) showed blood pressure monitoring at 9 AM for Lisinopril, there was no documentation of blood pressure readings for the 2 PM and 9 PM doses of Hydralazine. Further review of the electronic medical record's vital sign section revealed inconsistencies in recording blood pressures at the times Hydralazine was administered in the afternoon and evening. During an interview, the RN unit manager and the Assistant Director of Nursing confirmed that the MAR did not include a space to record blood pressure readings for all medications requiring such monitoring, corroborating the surveyor's findings.