Failure to Follow Physician Orders for Medication and Wound Care
Penalty
Summary
The facility failed to ensure that nursing services were provided in accordance with professional standards of quality by not following physician's orders for a resident with hypotension. The resident had a physician's order for Midodrine 5 mg to be administered three times daily as needed for low blood pressure, specifically when systolic was less than 100 or diastolic less than 60, and for vital signs to be taken every shift for seven days. Despite multiple documented instances where the resident's blood pressure readings met the criteria for administration of Midodrine, there was no evidence in the Medication Administration Record that the medication was given as ordered. Both a registered nurse and the Director of Nursing Services confirmed that the medication was not administered when indicated. Additionally, the facility did not follow a physician's order for wound care for the same resident. The order specified cleansing the left posterior calf with normal saline, patting dry, applying calcium alginate, and covering with bordered gauze every evening shift. On one evening shift, the wound treatment was not completed, and the nurse documented that the resident was sleeping. The Director of Nursing Services was unable to provide evidence that the wound care was performed as ordered on that date.