Failure to Reassess and Report Elevated Blood Pressure
Penalty
Summary
The deficiency involves the facility’s failure to reassess and report an elevated blood pressure for a resident with significant cardiac diagnoses. The facility’s Acute Changes in Condition Clinical Protocol requires nurses to monitor and report changes in condition, including vital signs, to the physician and to make pertinent observations and collect appropriate information before contacting the physician. The resident’s active care plan, which includes diagnoses of atrial fibrillation, hypertension, and heart failure, directs staff to monitor vital signs and report abnormalities to the physician. On the specified date and time, an LPN obtained blood pressure readings of 162/121 in the left arm and 170/100 in the right arm using an electronic blood pressure cuff and then administered Metoprolol Tartrate 50 mg. The resident’s blood pressure log for the month shows readings ranging from 130/72 to 170/100, with a 170/100 reading documented shortly after the elevated readings were obtained. However, there is no documentation that the resident’s blood pressure was reassessed after the initial elevated readings until several hours later, nor is there documentation that the elevated blood pressure was reported to the physician. In an interview, the LPN stated she did not perform any follow-up on the blood pressure because she considered it normal for the resident and observed no signs of distress, and she acknowledged that she did not reassess the blood pressure manually. The DON stated she would have expected the nurse to recheck the blood pressure manually and, if it remained elevated, to notify the physician.
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