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Based on record review and interview, the hospital failed to ensure compliance with the requirements of CFR 489.24 as evidenced by failing to provide further stabilizing treatment for an elevated blood pressure for 1 (#2) of 20 patients sampled when the hospital had the capacity and capability to treat the patient.

Based on record review and interview, the hospital failed to ensure that all patients who presented to the hospital's emergency department (ED) were provided appropriate stabilizing treatment for an emergency medical condition. This deficient practice is evidenced by failing to provide treatment for an elevated blood pressure for 1 (#2) of 20 patients sampled when the hospital had the capacity and capability to treat the patient.

Findings:

Review of Patient #2's emergency department medical record revealed the following:

Patient #2, 80-year-old Female, was triaged on 04/13/2021 at 11:57 a.m. as level 3 Urgent.

Complaint: she was sent from Clinic A for further evaluation of HTN. Asymptomatic on assessment. Triage by S3RN.

VS: BP 185/101

Last set of VS at 12:50 p.m. prior to MD exam: BP 212/99

S4MD checked the following boxes:

Nursing note reviewed and agree; Reliability of History- Good; Onset- Chronic; Location Generalized; Severity Moderate;

Review of Systems: all negative findings

Physical Exam: all documented WNL

Problem List: Labile Systematic Arterial Hypertension

Patient BP during stay 04/13/2021

11:57 a.m. 185/101

12:50 p.m. 212/99 shows on MD Emergency Department note as Last set of VS

1:35 p.m. 199/95

2:50 p.m. 201/90

No lab tests completed, no medications ordered or administered, no ED tests ordered, and no ED microbiology ordered.

1:35 p.m. S4MD note: We will repeat patient's blood pressure. If it is still below 200 we will discharge her to follow up with her primary physician for blood pressure medication adjustment.

2:40 p.m. S4MD note: The Patient's BP remains reasonable in the emergency room. She remains asymptomatic. We will continue her management outpatient.

04/13/2021 3:20 p.m. S4MD note: As she is leaving, the patient changed her story and stated she was trying to plug in with a PCP and that she does not have one. Stated she only has 1 BP pill left. I will put in SS consult for PCP and refill her medication.

Patient #2 was given a prescription for Carvedilol 12.5 mg.

Condition improved


A review of Patient #2's After Visit Summary from Clinic B dated 04/19/2021 at 12:15 p.m. revealed she was seen by a PA-C and treated for Hypertensive Urgency wth a BP of 212/109. She was administered Clonidine at 12:53 p.m. and the following test were completed: Chemistry Panel and 12 lead EKG. Amlodipine-benazepril 5-10 mg (Lotrel) prescription was called in to the pharmacy of Patient #2's choice.


In a telephone interview on 05/26/2021 at 12:59 p.m. S3RN when notified of S4MD's not about discharging Patient #2 if her repeat BP was below 200 and the BP at discharge was 201/90, S3RN stated he would normally notify the MD of such a high BP and he usually makes a note of it in the record.


In a telephone interview on 05/26/2021 at 1:30 p.m. S4MD stated he typically will medicate to lower such an elevated BP to some level for a sense of comfort and be on the correct level of medication. He admits to not remembering the incident and was going off what was told to him via the telephone interview. When notified of the 1:35 p.m. progress note written by S4MD that revealed he documented he would repeat Patient #2's BP and if below 200 we will DC and follow up with PCP for BP medication adjustment. S4MD stated, typically the MD is notified of elevated BP and he would have administered a medication to lower the BP of Patient #2.


In an interview on 05/26/2021 at 8:00 a.m. Patient #2 stated when she was discharged from the ED she was given a prescription for the same medication she was taking and it was not working. Patient #2 stated she did not feel comfortable, was dizzy. She also stated that her BP usually runs much lower that what it was in the ED and even suggested to staff, wouldn't 130/80 be better? Patient #2 also stated she followed up on 04/19/2021 at Clinic B for "Hypertensive Urgency" and her BP was 212/109. She stated they completed an EKG and labs. Patient #2 stated she was administered Clonidine to lower her BP and was given a different BP prescription, Amlodipine.