Failure to Follow Physician Parameters for Antihypertensive and Vasopressor Medications
Penalty
Summary
Surveyors identified a failure to provide pharmaceutical services in accordance with physician orders for one resident who had capacity and was readmitted to the facility in late November. The facility’s policy on medication administration required that medications be given according to written physician orders. The resident had orders for carvedilol 3.125 mg twice daily for hypertension, to be held only if systolic blood pressure (SBP) was less than 100 mmHg or heart rate was less than 60, and for midodrine (initially 2.5 mg, later increased to 5 mg) twice daily for hypotension, to be held if SBP exceeded specified thresholds (greater than 130 mmHg, later greater than 140 mmHg). Review of the MARs for December and January showed multiple instances where these parameters were not followed. In December, carvedilol was held on several occasions when documented BP and heart rate did not meet the ordered hold parameters, and in multiple instances the drug was held with no vital signs documented at all. Midodrine was held once when the BP was 127/71, which did not meet the ordered hold parameter, and was administered on several occasions when the recorded SBP exceeded the ordered threshold (e.g., SBP 145 and 152). Similar issues continued into January, with carvedilol held when vital signs did not meet hold criteria and with missing heart rate documentation, and midodrine both held without any documented vital signs and administered when SBP was above the ordered limit. During interviews, the DON verified these findings, and the Administrator acknowledged that facility policy required licensed nurses to follow physician orders.
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