Failure to Monitor and Manage Symptomatic Hypertension and Hypotension
Penalty
Summary
The deficiency involved the facility’s failure to provide appropriate treatment and monitoring for a resident with hypertension when the resident experienced significantly elevated blood pressure and related symptoms. The resident, admitted with a diagnosis including hypertension and having an impaired cognitive status (BIMS score of 9), had a physician’s order for Terazosin 1 mg at bedtime for systolic BP greater than 140. On the day in question, an eINTERACT Change in Condition Evaluation documented that the resident complained of dizziness and shakiness, with vital signs at 9:43 a.m. showing BP 157/122 mmHg. The RN reported that while passing morning medications, the resident complained of dizziness and shakiness and had a high BP of about 150/120. The RN stated she notified the physician around 9:40 a.m. and received orders to monitor the resident, provide supplemental oxygen, and obtain medical history, but the resident refused oxygen. Despite the elevated BP and ongoing symptoms, the RN acknowledged she did not monitor or recheck the resident’s BP between approximately 9 a.m. and 1 p.m. At around 1 p.m., the RN notified the physician that the resident continued to complain of dizziness and shakiness, had a BP of 78/59 mmHg and a heart rate of 120, and had a history of stroke; the physician then ordered the resident sent to the ER. The DON stated she was notified after 10 a.m. of the high BP and advised the RN to call the physician, and further stated that she expected the licensed nurse to call the physician for high BP with symptoms, obtain PRN medication, monitor BP at least hourly, follow up with the physician, and send the resident to the hospital if appropriate. Facility policies on blood pressure and change in condition required hypertensive and hypotensive readings and significant changes in condition to be reported to the physician, with multiple BP readings recorded at different times of day and prompt notification of the physician when treatment needed to be altered significantly.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.