Failure to Follow Physician Orders for Medication Administration
Penalty
Summary
The facility failed to follow professional standards of nursing practice for medication administration for a resident with multiple cardiovascular diagnoses, including paroxysmal atrial fibrillation, pulmonary embolism, popliteal vein thrombosis, hypertension, heart failure, and hypotension. The resident had physician orders for Midodrine to be given with meals for hypotension, to be held if systolic blood pressure was greater than 130, and for Metoprolol to be given once daily for cardiac arrhythmia, to be held if systolic blood pressure was less than 100, diastolic blood pressure less than 60, or heart rate less than 55. The orders also specified that Midodrine and Metoprolol should not be administered at the same time per the cardiologist. Observation and interviews revealed that an LPN administered both Metoprolol and Midodrine together at 9:39 AM, with the Midodrine being given late (scheduled for 8:00 AM) and not with a meal as ordered. The LPN acknowledged the error, stating that medication administration was difficult due to frequent interruptions. The unit manager confirmed that the medications were administered together, contrary to the physician's order, and explained that the medications have opposing effects on blood pressure and heart rate. The failure to follow the physician's orders and professional standards resulted in the resident not receiving medications as intended.