Failure to Follow BP Medication Hold Parameters for Antihypertensive Therapy
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for blood pressure medication parameters for one resident. The resident had diagnoses of essential hypertension and atherosclerotic heart disease of a native coronary artery without angina pectoris, and an order for losartan potassium 50 mg daily with instructions to hold the dose if the systolic blood pressure (SBP) was less than 110. The resident’s care plan for hypertension indicated goals for blood pressure management and interventions that included taking blood pressures as ordered, monitoring for pattern changes, and administering antihypertensive medications as ordered. Review of the medication administration record (MAR) for December showed multiple dates on which the resident’s SBP was below 110 (including readings such as 109/50, 101/52, 108/64, 109/79, and 103/68), yet the losartan was still administered and not held as ordered. Review of the MAR for January showed additional dates on which the resident’s SBP was below 110 (including readings such as 109/52, 108/73, 106/52, 108/66, 108/62, 105/46, and 107/55), and again the losartan was administered instead of being held per the physician’s parameters. Interviews with QMAs and an LPN indicated that staff were aware that blood pressure should be checked prior to administering antihypertensive medications and that medications with parameters should be held and the nurse notified if readings were outside the ordered range. One QMA, upon reviewing the MAR, acknowledged she should have held the medication when the SBP was below 110. The DON stated she expected staff to hold blood pressure medications when parameters were not met. The facility’s policy on following physician orders/parameters required licensed healthcare providers to consult and follow physician orders prior to administering medications or performing procedures, which was not followed in this case.
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