Repeated Administration of Metoprolol Outside Ordered Blood Pressure Parameters
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident was free from significant medication errors related to the administration of Metoprolol Succinate. The resident had a physician’s order for Metoprolol Succinate ER 150 mg by mouth once daily for essential hypertension, with explicit parameters to hold the medication if the systolic blood pressure (SBP) was below 110 or the heart rate (HR) was below 55. Despite this order, the Medication Administration Record (MAR) shows that nursing staff repeatedly administered the medication when the resident’s SBP was below the ordered threshold. The facility’s own “Medication Errors” policy defines a medication error as administration not in accordance with the prescriber’s order and states that the facility shall ensure medications are administered according to physician orders. The resident involved was admitted with multiple diagnoses, including secondary parkinsonism, COPD, type 2 diabetes mellitus, acute on chronic systolic congestive heart failure, essential hypertension, atrial fibrillation, and a coronary angioplasty implant and graft. A recent BIMS score of 15/15 indicated the resident was cognitively intact. The MAR documented that Metoprolol Succinate was administered on at least 14 occasions in December and 6 occasions in January with SBP readings below 110, including readings such as 91/45, 98/47, 88/58, and several others under the ordered SBP parameter. These administrations were counted as 20 significant medication errors between early December and late January, as they did not follow the physician’s hold parameters. Interviews with staff and leadership further established that the facility’s processes and staff knowledge acknowledged the requirement to follow vital sign parameters but did not prevent or correct the repeated errors. A medication tech stated that the MAR displays vital sign parameters, that medications should be held when vital signs fall outside those parameters, and that any such occurrence should be reported to the charge nurse with physician notification and monitoring. An RN who frequently worked on the resident’s hall confirmed that vital sign parameters are listed in the MAR, that medications should be held when parameters are not met, and that if a medication is given despite out-of-range vital signs, the physician should be called and the resident closely monitored. The NHA and DON both stated that parameters are written on the MAR, that medications should be held and physicians notified when parameters are not met, and agreed that the administrations in question were medication errors and that the Metoprolol should have been held on those occasions. Despite this, the MAR shows the medication was administered multiple times with SBP below the ordered threshold, constituting the cited deficiency.
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