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Based on medical record review and staff interview, the facility failed to ensure medications were administered according to physician prescribed parameters for 1 of 20 records reviewed. (Patient #5)

The findings include:

On 06/14/2023, an electronic medical record review was conducted for Patient #5 with the assistance of Staff Member A, a Licensed Practical Nurse and the Case Manager. Patient #5 was admitted to the hospital on 5/16/2023 for shortness of breath and edema and subsequently transferred to "swing bed" status on 05/23/2023. The patient had a medical history including hypertension. On 05/22/2023, the patient was prescribed Metoprolol (an anti-hypertensive medication) 50 mg (milligrams) daily with instructions and parameters to "Check heart rate and blood pressure prior to administration. Hold for heart rate <60 or systolic <100 or diastolic <60." There was also an order for Lisinopril 40mg (an anti-hypertensive medication), one tablet daily, with parameters stating, "Check blood pressure prior to administration. Hold for systolic <100 or diastolic <60." Both medications were scheduled to be administered at 10:00 AM.

A review of the Medication Administration Record (MAR) from 05/23/2023 to 6/14/23 revealed a failure to document a blood pressure or heart rate prior to administering the antihypertensive medications. Per review of the "Graphic and Intake & Output" records, there were vital signs obtained and documented between the hours of 3:00 AM - 7:00 AM daily and again for the evening shift. There were no vital signs ever recorded just prior to the administration of the 10:00 AM anti-hypertensive medications.

The following dates showed vital signs (which were documented between the hours of 3:00 AM - 7:00 AM) which would require holding the Metoprolol and Lisinopril, but the hospital failed to be follow the physician's order:
On 05/25/2023, the heart rate was 55. Metoprolol was still administered at 9:06 AM.
On 05/30/2023, the heart rate was 58. Metoprolol was still administered at 9:20 AM.
On 06/02/2023, the heart rate was 57. Metoprolol was still administered at 10:24 AM.
On 06/03/2023, the heart rate was 52. Metoprolol was still administered at 09:56 AM.
On 06/05/2023, no heart rate was obtained. Metoprolol was still administered at 9:13 AM.
On 06/10/2023, the heart rate was 50. Metoprolol was still administered at 09:25 AM.
On 06/13/2023, the blood pressure was 109/52. Metoprolol was still administered 09:34 AM. Lisinopril was still administered 09:37 AM.

On 06/14/2023, at approximately 09:45 AM, Staff Member A, a Licensed Practical Nurse and the Case Manager, stated that, prior to administering the blood pressure medication, the record 'alerts' the nurse to ensure the parameters are followed. She was not able to locate any vital signs taken around the time the antihypertensive medications were administered. She stated that the night shift, prior to the end of shift, takes the morning set of vital signs around 6:00 AM, approximately 4 hours before the 10:00 AM medications are due for administration.

On 06/14/2023 at approximately 11:45 AM, an interview was conducted with the Director of Nursing (DON). She stated she expected vital signs to be taken just prior to administering anti-hypertensives when physician prescribed parameters are included. This should be documented in the Medication Administration Record.