Failure to Follow Antihypertensive Medication Parameters and Document BPs
Penalty
Summary
The deficiency involves the facility’s failure to ensure that antihypertensive medication was administered in accordance with professional standards and the physician’s ordered parameters for one resident. The resident had diagnoses including dementia and hypertension and a physician’s order for losartan 50 mg by mouth once daily, with instructions to hold the medication for systolic blood pressure less than 100 or blood pressure less than 100/60. Review of the Medication Administration Records from mid-October through early March showed that losartan was documented as administered on most days, but there was no documentation of the resident’s blood pressure with each administration, and blood pressures were only recorded on six occasions that could possibly coincide with the losartan dosing. Review of the vitals documentation revealed no evidence that blood pressures were taken consistently prior to administering a medication with specific blood pressure parameters. Further review of the clinical record progress notes showed that on three dates the losartan was held and coded as “5=Hold See Progress Notes.” On two of those dates, the medication was held due to a pulse of 56, which was not included in the physician’s parameters for holding the medication. On the third date, the medication was held for a blood pressure of 99/54, which met the ordered hold parameters. During an interview, the DON stated she could not confirm that nurses consistently took the resident’s blood pressure before administering losartan and suggested that nurses may have taken blood pressures and written them on report sheets instead of documenting them in the clinical record. She confirmed that there should have been a corresponding documentation field with the medication administration to record the blood pressure and demonstrate that the physician’s ordered parameters were followed.
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