Failure to Follow Midodrine Blood Pressure Parameters for Two Residents
Penalty
Summary
The facility failed to follow physician orders for administration of the blood pressure medication midodrine for two residents. For one resident with hypertension and renal dialysis, a physician ordered midodrine to be given three times a day on certain days of the week and twice a day on the remaining days, with a specific parameter that the medication was not to be administered if the resident’s systolic blood pressure (SBP) was greater than 130 mm/Hg. Review of this resident’s Medication Administration Records (MARs) for December 2025 and January 2026 showed that staff administered midodrine three times in December and four times in January when the resident’s SBP exceeded 130 mm/Hg, contrary to the physician’s order. For another resident with hypotension, chronic respiratory failure, and peripheral vascular disease, a physician ordered midodrine three times a day with the instruction that it was not to be administered if the SBP was greater than 120 mm/Hg. Review of this resident’s MARs for October, November, and December 2025, and January 2026 revealed that staff administered midodrine 28 times in October, 39 times in November, 26 times in December, and two times in January when the SBP was greater than 120 mm/Hg, again outside the ordered parameters. In an interview, the Director of Nursing confirmed that the medications for both residents were administered outside the parameters ordered by the physicians.
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