Failure to Follow Hold Parameters for Antihypertensive Medications
Penalty
Summary
The deficiency involves the facility’s failure to follow physician-ordered parameters for administering antihypertensive medications to one resident. The resident had diagnoses of hypertension and congestive heart failure, a BIMS score of 12 indicating moderately impaired cognition, dependence on staff for ADLs, and was receiving an anticoagulant and a diuretic. The care plan directed staff to administer medications as ordered, obtain vital signs at least daily per physician orders and as needed, and notify the physician of any abnormal readings. Physician orders for isosorbide mononitrate 30 mg daily and amlodipine 10 mg daily included explicit parameters to hold the medications if pulse was less than 50 BPM or greater than 120 BPM, or if BP was less than 120/40 or greater than 200/90 mm/Hg. Review of the resident’s MARs showed that both antihypertensive medications were administered multiple times when BP and/or pulse readings were outside the ordered parameters over several months. In November, each medication was given outside parameters on 6 of 30 opportunities; in December, on 12 of 30 opportunities; in January, on 15 of 30 opportunities; and in February, on 5 of 24 opportunities. Staff interviews revealed that the consultant pharmacist interpreted the parameters as directions to hold the medications when readings were outside the ordered ranges, a CMA reported she would retake low readings and notify the nurse and hold the medication if still low, and an LN and administrative nurse both stated that medications should be held when BP or pulse readings were outside the ordered parameters. The facility’s medication and treatment orders policy required that physician orders be followed and that the DON/designee and physician be notified if orders could not be followed, but the documented MARs showed repeated administration of the antihypertensives contrary to those parameters.
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