Aperion Care Marion Llc

During an interview, on 9/9/25 at 3:41 p.m., RN 3 indicated when a medication had blood pressure and heart rate parameters, she obtained the blood pressure and heart rate.

She administered the medication if the blood pressure and heart rate met the parameters. If the medication order was unclear, she would call the physician to get further instructions.

• Resident B's clinical record was reviewed on 9/9/25 at 12:20 p.m.

Diagnoses included atherosclerotic heart disease of native coronary artery with unstable angina pectoris, unspecified combined systolic (congestive) and diastolic (congestive) heart failure, and essential (primary) hypertension.

Physician orders included midodrine 5 mg every eight hours as needed (PRN) for hypotension (low blood pressure) administer for systolic blood pressure (SBP) less than 90 (started 3/17/25) and blood pressure monitoring three times a day for hypotension - administer PRN midodrine 5 mg for SBP less than 90. An annual Minimum Data Set (MDS) assessment, dated 8/2/25, indicated the resident was moderately cognitively impaired. No behaviors were marked. A care plan for coronary artery disease was initiated on 1/28/24.

Interventions included give medications for hypertension and document response to medication and any side effects (1/28/24) and monitor blood pressure and notify physician of any abnormal readings (1/28/24).

A medication administration record (MAR) for July 2025 indicated the following: On 7/1/25 at 3:00 p.m., the resident's blood pressure was 88/54.

The MAR lacked an entry for the administration of midodrine on 7/1/25. On 7/11/25 at 7:00 a.m., the resident's blood pressure was 83/49.

The MAR lacked an entry for the administration of midodrine on 7/11/25. On 7/19/25 at 7:00 a.m., the resident's blood pressure was 88/61.

The MAR lacked an entry for the administration of midodrine on 7/19/25. On 7/24/25 at 7:00 a.m., the resident's blood pressure was 73/41. On 7/24/25 at 3:00 p.m., the resident's blood pressure was 86/54.

The MAR lacked an entry for the administration of midodrine on 7/24/25. On 8/1/25 at 7:00 a.m., the resident's blood pressure was 88/57.

The MAR lacked an entry for the administration of midodrine on 8/1/25. On 9/8/25 at 7:00 p.m., the resident's blood pressure was 86/54.

The MAR lacked an entry for the administration of midodrine on 9/8/25.

During an interview on 9/9/25 at 3:47 p.m., LPN 4 indicated when a medication required a blood pressure or heart rate to be a certain number, she obtained the blood pressure and/or heart rate and administered or held the medication as ordered. If she had questions, she notified the nurse practitioner to get more clarification.

During an interview on 9/9/25 at 3:59 p.m., LPN 5 indicated, for medications that required blood pressure or heart rate monitoring, she obtained the blood pressure and heart rate and administered the medication if the readings met the ordered parameters. If the readings did not meet the parameters, then she held the medication as ordered.

For any discrepancies in the order, she called the physician. It was important to pay attention to the orders.

During an interview, on 9/9/25 at 4:11 p.m., the Director of Nursing (DON) indicated the staff should be following the parameters on medication orders.

Multiple physicians provided care for Resident D, thus his medications had different parameters.

During an interview, on 9/9/25 at 4:58 p.m., the DON indicated the physician orders should have been followed, and the medications should have been given or held according to the blood pressure and/or heart rate parameters.

During an interview, on 9/9/25 at 5:01 p.m., the Administrator indicated the facility did not have a policy on following physician orders.

The facility followed Federal and State guidelines. 3.1-37(a)

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