Failure to Follow Physician Orders for Medication Administration Parameters
Penalty
Summary
The deficiency involves failure to implement physician orders and follow ordered parameters for medication administration for three residents. One resident with hypotension, end stage renal disease, and dependence on renal dialysis had an order for midodrine once daily at 9:00 a.m. on Monday, Wednesday, and Friday, and a separate order to leave the facility at 5:30 a.m. on those same days for dialysis. Review of the MARs showed that on multiple occasions in February and March the resident was documented as out of the facility at dialysis and the midodrine dose was not given, with no evidence that the physician was notified of the missed doses or that the medication schedule was adjusted to account for dialysis days. Another resident with diabetes and chronic kidney disease had physician orders for scheduled doses of insulin aspart and insulin glargine at specified times each day, with instructions to hold the insulin if blood sugar was less than 120 mg/dL. MAR review showed that staff administered insulin glargine on four occasions and insulin aspart on two occasions when the resident’s blood sugar was below 120 mg/dL, contrary to the orders. A third resident with hypotension had an order for midodrine three times a day, with instructions to hold the medication if systolic blood pressure (SBP) was greater than 120 mm/Hg. MAR review revealed that staff administered midodrine once in February and seven times in March when the resident’s SBP exceeded 120 mm/Hg. In an interview, the DON confirmed that nurses were expected to notify the physician of missed doses by the next day and acknowledged that the required notifications and holds did not occur as ordered.
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