Failure to Clarify PRN Blood Pressure Medication Orders and Monitor Blood Pressure
Penalty
Summary
Facility staff failed to clarify and appropriately implement physician orders for as-needed blood pressure medications for one resident. The resident had a physician order for Midodrine 10 mg via PEG tube every eight hours as needed for orthostatic hypotension, to be given when systolic blood pressure (SBP) was under 100 mmHg, and a separate order for Clonidine to be given by mouth every eight hours as needed for hypertension, to be given when SBP was over 170 mmHg. Review of the clinical record did not show that the resident’s blood pressure was being taken every eight hours to determine whether either of these PRN medications was needed. During an interview, an LPN stated that when a medication requires a blood pressure check, the nurse should take the blood pressure and then administer or hold the medication according to the physician’s order. In another interview, the regional director of clinical services reported that the facility had previously been cited regarding Midodrine orders and had addressed this with physicians by changing such orders from PRN to scheduled doses with hold parameters, and also stated that it was unusual to have a PRN order for Clonidine and that these orders needed clarification. Administrative staff, including the administrator, DON, and regional director of operations, were informed of these findings, and no additional information was provided before survey exit.
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