Failure to Follow Blood Pressure Management Policy for Hypertensive Resident
Penalty
Summary
The deficiency involves the facility’s failure to follow its own blood pressure management policy and professional standards of quality care for one resident with a history of hypertension and malignant neoplasm of the rectum and colon. The facility’s policy defined hypertension as BP over 140/90 mmHg and hypotension as BP less than 100/60 mmHg, and required that such abnormal readings be reported to the physician and followed by several additional BP measurements at different times of day. The resident was admitted on antihypertensive medications (amlodipine 10 mg daily and lisinopril 40 mg daily). On one date, the resident’s BP was recorded as 86/53, which met the facility’s definition of hypotension. No further BP readings were documented between that date and a later date in October, despite the policy requirement for multiple follow-up readings and physician communication for hypotensive values. Subsequent BP records for the same resident showed multiple readings that met the facility’s definitions of either hypertension or hypotension, including values such as 142/90, 141/97, 166/129, 143/97, 95/57, and 142/100. According to facility policy, each of these abnormal readings required additional BP measurements and notification of the physician. The clinical record contained no documentation of follow-up BP measurements for these abnormal readings and no indication in the progress notes that the physician was informed of them. Although physician orders showed that the resident’s antihypertensive medications were discontinued on the same date as the initial hypotensive reading, the deficiency centers on the lack of required follow-up measurements and failure to report subsequent abnormal BP values. In an interview, the Medical Director confirmed that staff did not comply with the facility’s policy regarding obtaining additional BP measurements after abnormal readings and reporting the results to the physician.
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