Failure to Follow Blood Pressure Hold Parameters for Midodrine
Penalty
Summary
The deficiency involves the facility’s failure to follow a physician’s order for holding a blood pressure medication according to specified parameters for one resident. The resident had multiple diagnoses, including Alzheimer’s disease, vascular dementia with psychotic disturbance, psychotic disorder with delusions, adjustment disorder with anxiety, muscle weakness, and hypotension, and was care planned as being at risk for fluid imbalance due to blood pressure issues, with an intervention to administer medications as ordered. A physician’s order directed that 5 mg of midodrine be given every morning and held if the systolic blood pressure (SBP) was greater than 130. Review of the Medication Administration Records over several months showed that midodrine was administered despite SBP readings above the ordered hold parameter on multiple occasions: SBP 155 and 135 in December, SBP 138 and 137 in January, and SBP 153 in February. Interviews with an LPN and the DON confirmed that medications with hold parameters should be withheld when vital signs fall outside those parameters, and that held medications should be documented with initials in parentheses on the MAR. The ADON reported there was no specific facility policy addressing medication parameters, while the general medication administration policy required staff to take necessary measures, including obtaining vital signs, prior to administration.
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