Failure to Provide Ordered Antihypertensive Medications Due to Pharmacy Supply Issues
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered routine antihypertensive medications and to ensure pharmaceutical services that accurately acquire, receive, dispense, and administer drugs as required. Facility policy titled “Policy Services Overview,” revised April 2019, states that pharmacy services are available 24 hours a day, seven days a week, and that residents will have a sufficient supply of prescribed medications and receive them in a timely manner. Despite this policy, the facility did not ensure that medications were available and administered as ordered. Resident 2, admitted on February 25, 2026, had diagnoses including hypertension and muscle weakness and had physician orders for Amlodipine Besylate 5 mg by mouth once daily and Valsartan-Hydrochlorothiazide 320-25 mg by mouth once daily for essential hypertension. Review of the Medication Administration Record for February 1–28, 2026, showed that both medications were not administered on February 26, 2026, as ordered. A progress note for that date documented that the medications were not given because the facility was “awaiting delivery,” and that the RN Supervisor, resident representative, and provider were aware. In an interview, the Director of Nursing acknowledged that the ordered medications were not available from the contracted pharmacy.
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