Failure to Safely Monitor and Administer Antihypertensive Medication
Penalty
Summary
The deficiency involves the facility’s failure to ensure appropriate monitoring and safe administration of metoprolol for a resident treated for hypertension. The resident was admitted with multiple diagnoses including diabetes mellitus, anemia, atrial fibrillation, acute respiratory failure with hypoxia, and chronic kidney disease. Progress notes documented that on one day the resident had a blood pressure of 100/58, appeared deeply asleep, refused medications and food at lunchtime, and then went back to sleep. The following day, progress notes documented a blood pressure of 86/58, lethargy, slow response, pallor, and that the resident was not responding per baseline, leading to physician contact and transfer to the emergency room. Review of the Medication Administration Record (MAR) showed that the resident had a physician order for metoprolol tartrate 12.5 mg by mouth twice daily for hypertension. The MAR documented multiple low blood pressure readings in January and February, including systolic readings at or near 100 mmHg, on days when metoprolol was administered. A licensed nurse confirmed that she administered metoprolol on days when low blood pressure readings were recorded and acknowledged that when blood pressure medication orders do not include parameters, the nurse should assess the resident, review blood pressure readings, notify the physician, and request clarification for safe parameters. She further stated that if metoprolol had included parameters for holding the medication, the recent change in the resident’s condition that resulted in hospitalization due to very low blood pressure might have been avoided. The DON stated that the facility’s process for administering blood pressure medications included holding parameters based on diagnosis: for residents treated for hypertension, nurses should hold blood pressure medication if systolic blood pressure is less than 110, and for residents treated for heart failure, if systolic blood pressure is less than 100. The DON’s review of the MAR confirmed that metoprolol was administered multiple times when the resident’s systolic blood pressure was below 110, which was not consistent with the facility’s stated process. The DON also confirmed that the resident did not have a care plan addressing hypertension or the use of metoprolol, including monitoring for potential adverse effects and its black box warning. Additionally, the February Medication Regimen Review completed by the consultant pharmacist included the resident but did not contain any recommendations regarding the lack of medication parameters or the documented low blood pressure readings.
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