Failure to Follow Physician Orders for Medication and Treatment
Penalty
Summary
The facility failed to implement physician's orders for two residents, resulting in deficiencies related to medication administration and prescribed treatments. For one resident with hypertension and requiring renal dialysis, staff were ordered to administer metoprolol tartrate twice daily, withholding the medication if the systolic blood pressure (SBP) was less than 110 mmHg. However, documentation showed that the medication was administered 85 times without evidence that blood pressure was assessed prior to administration as required. Additionally, the same resident had an order for hydralazine to be given every eight hours as needed if SBP exceeded 170 mmHg, but there was no evidence that the medication was administered on five occasions when the SBP was above this threshold. Another resident with a history of stroke, diabetes, and muscle wasting had a physician's order for a compression stocking to be applied to the left lower leg in the morning and removed in the evening to address leg swelling. Multiple observations over several days revealed that the resident was seen in the hallway in a wheelchair with visible ankle swelling and without the compression stocking in place. The Director of Nursing confirmed that the compression stocking should have been applied according to the physician's order.