Health inspection·July 2, 2023

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure that residents were free of any significant medication errors for 4 (Resident #2, #3, #4, and #5) of 6 residents reviewed for safe administration of midodrine [a medication intended to raise systolic blood pressure], in that: Residents Affected - Some 1. Resident #2 was administered midodrine on 9 instances outside of the parameters established by the Primary Care Physician (PCP) to hold if greater than 120 systolic blood pressure between 4/01/2023-6/30/2023; 2. Resident #3 was administered midodrine on 45 instances outside of the parameters established by the PCP to hold if greater than 100 systolic blood pressure between 4/01/2023-6/30/2023; 3. Resident #4 was administered midodrine on 47 instances outside of the parameters established by the PCP to hold if greater than 120 systolic blood pressure between 4/01/2023-6/30/2023; 4. Resident #5 was administered midodrine on 18 instances outside of the parameters established by the PCP to hold if greater than 120 systolic blood pressure between 4/01/2023-6/30/2023; This failure could place residents at risk of not receiving the intended therapeutic benefit of drugs and biologics, worsening or exacerbation of chronic medical conditions, and place residents at risk for serious injuries up to and including strokes. The findings included: 1. Record review of admission Record , dated 7/02/2023, revealed Resident #2 was a [AGE] year-old male admitted on [DATE]. Diagnoses included hypotension [low blood pressure]. Record review of quarterly MDS [Minimum Data Set] assessment, dated 5/25/2023, revealed Resident #2's primary reason for admission was debility, cardiorespiratory conditions. Other active diagnoses included: orthostatic hypotension [form of low blood pressure that happens when you stand up from sitting or lying down]. Record review of Resident #2's Care Plan, revised on 2/15/2023, revealed a problem area of, Hypotension; associated interventions included, give medications as ordered, initiated on 2/01/2023. Record review of Resident #2's Order Summary Report, dated 7/02/2023, revealed active orders for: Midodrine HCL [hydrochloride], oral, tablet 5 MG [milligram], give one tablet by mouth three times a day for hypotension, hold for SBP [systolic blood pressure] > [greater than] 120; start date Page 1 of 11 675409 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 2/07/2023. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #2's Medication Administration Record [MAR] for the months of April, May, and June 2023 revealed: Residents Affected - Some *Midodrine was administered out of parameters on 4/21/2023 at 7:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 4/27/2023 at 7:00 PM when the systolic blood pressure was 122 administered by [unnamed staff]. *Midodrine was administered out of parameters on 5/08/2023 at 7:00 PM when the systolic blood pressure was 134 administered by LVN A. *Midodrine was administered out of parameters on 5/21/2023 at 7:00 PM when the systolic blood pressure was 134 administered by [unnamed staff]. *Midodrine was administered out of parameters on 5/22/2023 at 7:00 AM when the systolic blood pressure was 136 administered by LVN F. *Midodrine was administered out of parameters on 5/22/2023 at 1:00 PM when the systolic blood pressure was 124 administered by LVN F. *Midodrine was administered out of parameters on 5/22/2023 at 7:00 PM when the systolic blood pressure was 122 administered by LVN A. *Midodrine was administered out of parameters on 6/14/2023 at 1:00 PM when the systolic blood pressure was 126 administered by [unnamed staff]. *Midodrine was administered out of parameters on 6/14/2023 at 7:00 PM when the systolic blood pressure was 122 administered by LVN A. 2. Record review of admission Record , dated 7/02/2023, revealed Resident #3 was a [AGE] year-old female admitted on [DATE]. Diagnoses included hypotension. Record review of annual MDS assessment, dated 6/15/2023, revealed Resident #3's primary reason for admission was medically complex conditions. Other active diagnoses included: orthostatic hypotension. Record review of Resident #3's Care Plan, revised on 6/27/2023, did not include a problem area or associated interventions for hypotension or other cardiovascular issues. Record review of Resident #3's Order Summary Report, dated 7/02/2023, revealed active orders for: Midodrine HCL, oral, tablet 10 MG, give one tablet by mouth three times a day for hypotension, hold for SBP > 100; start date 3/20/2023. Record review of Resident #3's MAR for the months of April, May, and June 2023 revealed: *Midodrine was administered out of parameters on 4/03/2023 at 7:00 PM when the systolic blood 675409 Page 2 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 pressure was 132 administered by LVN A. Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 4/04/2023 at 7:00 AM when the systolic blood pressure was 112 administered by LVN F. Residents Affected - Some *Midodrine was administered out of parameters on 4/04/2023 at 1:00 PM when the systolic blood pressure was 112 administered by LVN F. *Midodrine was administered out of parameters on 4/05/2023 at 7:00 AM when the systolic blood pressure was 110 administered by LVN F. *Midodrine was administered out of parameters on 4/05/2023 at 1:00 PM when the systolic blood pressure was 110 administered by LVN F. *Midodrine was administered out of parameters on 4/07/2023 at 7:00 AM when the systolic blood pressure was 112 administered by LVN D. *Midodrine was administered out of parameters on 4/10/2023 at 7:00 AM when the systolic blood pressure was 120 administered by LVN F. *Midodrine was administered out of parameters on 4/10/2023 at 1:00 PM when the systolic blood pressure was 120 administered by LVN F. *Midodrine was administered out of parameters on 4/12/2023 at 7:00 AM when the systolic blood pressure was 116 administered by LVN F. *Midodrine was administered out of parameters on 4/14/2023 at 7:00 PM when the systolic blood pressure was 110 administered by LVN A. *Midodrine was administered out of parameters on 4/15/2023 at 7:00 AM when the systolic blood pressure was 126 administered by LVN D. *Midodrine was administered out of parameters on 4/16/2023 at 7:00 AM when the systolic blood pressure was 111 administered by LVN F. *Midodrine was administered out of parameters on 4/16/2023 at 1:00 PM when the systolic blood pressure was 111 administered by LVN F. *Midodrine was administered out of parameters on 4/17/2023 at 7:00 AM when the systolic blood pressure was 104 administered by LVN F. *Midodrine was administered out of parameters on 4/17/2023 at 1:00 PM when the systolic blood pressure was 104 administered by LVN F. *Midodrine was administered out of parameters on 4/20/2023 at 7:00 PM when the systolic blood pressure was 114 administered by LVN A. *Midodrine was administered out of parameters on 4/21/2023 at 7:00 PM when the systolic blood pressure was 118 administered by LVN A. 675409 Page 3 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 4/22/2023 at 7:00 AM when the systolic blood pressure was 125 administered by LVN F. *Midodrine was administered out of parameters on 4/22/2023 at 1:00 PM when the systolic blood pressure was 125 administered by LVN F. Residents Affected - Some *Midodrine was administered out of parameters on 4/23/2023 at 7:00 AM when the systolic blood pressure was 114 administered by LVN F. *Midodrine was administered out of parameters on 4/23/2023 at 1:00 PM when the systolic blood pressure was 114 administered by LVN F. *Midodrine was administered out of parameters on 4/24/2023 at 7:00 AM when the systolic blood pressure was 126 administered by LVN D. *Midodrine was administered out of parameters on 4/25/2023 at 1:00 PM when the systolic blood pressure was 106 administered by LVN D. *Midodrine was administered out of parameters on 4/26/2023 at 7:00 PM when the systolic blood pressure was 112 administered by LVN A. *Midodrine was administered out of parameters on 4/28/2023 at 7:00 AM when the systolic blood pressure was 124 administered by LVN F. *Midodrine was administered out of parameters on 5/02/2023 at 7:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 5/05/2023 at 7:00 AM when the systolic blood pressure was 112 administered by LVN F. *Midodrine was administered out of parameters on 5/08/2023 at 7:00 PM when the systolic blood pressure was 114 administered by LVN A. *Midodrine was administered out of parameters on 5/09/2023 at 7:00 AM when the systolic blood pressure was 103 administered by LVN B. *Midodrine was administered out of parameters on 5/09/2023 at 7:00 PM when the systolic blood pressure was 132 administered by LVN A. *Midodrine was administered out of parameters on 5/13/2023 at 1:00 PM when the systolic blood pressure was 110 administered by LVN D. *Midodrine was administered out of parameters on 5/15/2023 at 7:00 AM when the systolic blood pressure was 117 administered by LVN C. *Midodrine was administered out of parameters on 5/15/2023 at 1:00 PM when the systolic blood pressure was 122 administered by LVN C. *Midodrine was administered out of parameters on 5/15/2023 at 7:00 PM when the systolic blood 675409 Page 4 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 pressure was 129 administered by LVN C. Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 5/21/2023 at 1:00 PM when the systolic blood pressure was 128 administered by LVN D. Residents Affected - Some *Midodrine was administered out of parameters on 5/21/2023 at 7:00 PM when the systolic blood pressure was 102 administered by LVN B. *Midodrine was administered out of parameters on 5/22/2023 at 7:00 PM when the systolic blood pressure was 134 administered by LVN A. *Midodrine was administered out of parameters on 5/23/2023 at 7:00 AM when the systolic blood pressure was 102 administered by LVN F. *Midodrine was administered out of parameters on 5/23/2023 at 1:00 PM when the systolic blood pressure was 101 administered by LVN F. *Midodrine was administered out of parameters on 5/26/2023 at 6:00 AM when the systolic blood pressure was 122 administered by LVN A. *Midodrine was administered out of parameters on 5/27/2023 at 7:00 AM when the systolic blood pressure was 132 administered by LVN D. *Midodrine was administered out of parameters on 5/28/2023 at 1:00 PM when the systolic blood pressure was 111 administered by [unnamed staff]. *Midodrine was administered out of parameters on 5/31/2023 at 1:00 PM when the systolic blood pressure was 101 administered by [unnamed staff]. *Midodrine was administered out of parameters on 6/01/2023 at 7:00 PM when the systolic blood pressure was 112 administered by LVN A. *Midodrine was administered out of parameters on 6/02/2023 at 7:00 PM when the systolic blood pressure was 134 administered by LVN A. 3. Record review of admission Record , dated 7/02/2023, revealed Resident #4 was a [AGE] year-old male, admitted on [DATE]. Diagnosis included atrial fibrillation [disease of the heart, characterized by irregular and often faster heartbeat; frequently associated with low blood pressure]. Record review of annual MDS assessment, dated 4/06/2023, revealed Resident #4's primary reason for admission was progressive neurological conditions. Other active diagnoses included: atrial fibrillation. Record review of Resident #4's Care Plan, revised on 6/27/2023, revealed a problem area of, Hypertension [not included on admission Record or MDS assessment] related to lifestyle choices; Interventions listed are associated with hypertension [high blood pressure], not hypotension. Record review of Resident #4's Order Summary Report, dated 7/02/2023, revealed active orders for: Midodrine HCL oral, tablet 5 MG, give one tablet by mouth every 6 hours for hypotension, hold for SBP 675409 Page 5 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 > 120; start date 3/03/2023. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #4's MAR for the months of April, May, and June 2023 revealed: Residents Affected - Some *Midodrine was administered out of parameters on 4/01/2023 at 6:00 AM when the systolic blood pressure was 130 administered by LVN C. *Midodrine was administered out of parameters on 4/01/2023 at 12:00 PM when the systolic blood pressure was 126 administered by LVN C. *Midodrine was not administered on 4/01/2023 at 6:00 PM when the systolic blood pressure was 118 held by [unnamed staff]. *Midodrine was administered out of parameters on 4/06/2023 at 12:00 PM when the systolic blood pressure was 124 administered by LVN C. *Midodrine was administered out of parameters on 4/11/2023 at 6:00 AM when the systolic blood pressure was 121 administered by LVN B. *Midodrine was administered out of parameters on 4/11/2023 at 12:00 PM when the systolic blood pressure was 124 administered by LVN B. *Midodrine was administered out of parameters on 4/17/2023 at 12:00 PM when the systolic blood pressure was 124 administered by LVN C. *Midodrine was administered out of parameters on 4/17/2023 at 6:00 PM when the systolic blood pressure was 126 administered by LVN A. *Midodrine was administered out of parameters on 4/18/2023 at 6:00 AM when the systolic blood pressure was 155 administered by LVN B. *Midodrine was administered out of parameters on 4/22/2023 at 12:00 PM when the systolic blood pressure was 125 administered by LVN C. *Midodrine was administered out of parameters on 4/22/2023 at 6:00 PM when the systolic blood pressure was 122 administered by LVN C. *Midodrine was administered out of parameters on 4/26/2023 at 6:00 AM when the systolic blood pressure was 127 administered by LVN B. *Midodrine was administered out of parameters on 4/29/2023 at 12:00 PM when the systolic blood pressure was 122 administered by LVN C. *Midodrine was administered out of parameters on 4/29/2023 at 6:00 PM when the systolic blood pressure was 124 administered by LVN C. *Midodrine was administered out of parameters on 4/30/2023 at 12:00 PM when the systolic blood pressure was 124 administered by LVN C. 675409 Page 6 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 5/04/2023 at 6:00 PM when the systolic blood pressure was 158 administered by LVN A. *Midodrine was administered out of parameters on 5/05/2023 at 12:00 PM when the systolic blood pressure was 122 administered by LVN C. Residents Affected - Some *Midodrine was administered out of parameters on 5/06/2023 at 12:00 PM when the systolic blood pressure was 122 administered by LVN C. *Midodrine was administered out of parameters on 5/07/2023 at 12:00 PM when the systolic blood pressure was 123 administered by LVN C. *Midodrine was administered out of parameters on 5/07/2023 at 6:00 PM when the systolic blood pressure was 122 administered by LVN A. *Midodrine was administered out of parameters on 5/10/2023 at 6:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 5/11/2023 at 6:00 AM when the systolic blood pressure was 123 administered by LVN B. *Midodrine was administered out of parameters on 5/11/2023 at 12:00 PM when the systolic blood pressure was 125 administered by LVN C. *Midodrine was administered out of parameters on 5/11/2023 at 6:00 PM when the systolic blood pressure was 126 administered by LVN A. *Midodrine was administered out of parameters on 5/17/2023 at 6:00 AM when the systolic blood pressure was 124 administered by LVN B. *Midodrine was administered out of parameters on 5/17/2023 at 12:00 PM when the systolic blood pressure was 127 administered by LVN C. *Midodrine was administered out of parameters on 5/18/2023 at 12:00 PM when the systolic blood pressure was 126 administered by LVN C. *Midodrine was administered out of parameters on 5/19/2023 at 12:00 AM when the systolic blood pressure was 126 administered by LVN B. *Midodrine was administered out of parameters on 5/19/2023 at 6:00 AM when the systolic blood pressure was 127 administered by LVN B. *Midodrine was administered out of parameters on 5/19/2023 at 12:00 PM when the systolic blood pressure was 129 administered by LVN C. *Midodrine was administered out of parameters on 5/20/2023 at 12:00 AM when the systolic blood pressure was 123 administered by LVN B. *Midodrine was administered out of parameters on 5/22/2023 at 6:00 PM when the systolic blood 675409 Page 7 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 pressure was 121 administered by LVN C. Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 5/23/2023 at 12:00 AM when the systolic blood pressure was 150 administered by LVN B. Residents Affected - Some *Midodrine was administered out of parameters on 5/23/2023 at 6:00 AM when the systolic blood pressure was 140 administered by LVN B. *Midodrine was administered out of parameters on 5/23/2023 at 12:00 PM when the systolic blood pressure was 123 administered by LVN C. *Midodrine was administered out of parameters on 5/26/2023 at 6:00 AM when the systolic blood pressure was 132 administered by LVN A. *Midodrine was administered out of parameters on 5/24/2023 at 6:00 AM when the systolic blood pressure was 124 administered by LVN B. *Midodrine was administered out of parameters on 6/06/2023 at 12:00 PM when the systolic blood pressure was 132 administered by LVN A. *Midodrine was administered out of parameters on 6/15/2023 at 6:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 6/16/2023 at 12:00 PM when the systolic blood pressure was 122 administered by LVN C. *Midodrine was administered out of parameters on 6/16/2023 at 6:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 6/17/2023 at 12:00 PM when the systolic blood pressure was 125 administered by LVN C. *Midodrine was administered out of parameters on 6/19/2023 at 6:00 AM when the systolic blood pressure was 123 administered by LVN B. *Midodrine was administered out of parameters on 6/21/2023 at 6:00 PM when the systolic blood pressure was 122 administered by LVN A. *Midodrine was administered out of parameters on 6/22/2023 at 6:00 PM when the systolic blood pressure was 122 administered by LVN A. *Midodrine was administered out of parameters on 6/28/2023 at 6:00 PM when the systolic blood pressure was 134 administered by LVN A. *Midodrine was administered out of parameters on 6/29/2023 at 12:00 PM when the systolic blood pressure was 129 administered by LVN C. 4. Record review of admission Record , dated 7/02/2023, revealed Resident #5 was a [AGE] year-old female, admitted on [DATE]. Diagnoses included hypotension and bradycardia [abnormally slow 675409 Page 8 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 heartbeat]; and heart failure. Level of Harm - Minimal harm or potential for actual harm Record review of annual MDS assessment, dated 5/08/2023, revealed Resident #5's primary reason for admission was medically complex conditions. Other active diagnoses included: orthostatic hypotension. Residents Affected - Some Record review of Resident #5's Care Plan, revised on 7/04/2019, revealed a problem area of, Hypotension; associated interventions included, give medications as ordered, initiated 7/04/2019. Record review of Resident #5's Order Summary Report, dated 7/02/2023, revealed active orders for: Midodrine HCL, oral, tablet 5 MG, give one tablet by mouth three times a day for hypotension, hold for systolic greater than 120 or diastolic greater than 70; start date 2/07/2023. Record review of Resident #5's MAR for the months of April, May, and June 2023 revealed: *Midodrine was administered out of parameters on 4/03/2023 at 1:00 PM when the systolic blood pressure was 122 administered by [unnamed staff]. *Midodrine was administered out of parameters on 4/11/2023 at 7:00 AM when the systolic blood pressure was 125 administered by LVN F. *Midodrine was administered out of parameters on 4/11/2023 at 1:00 PM when the systolic blood pressure was 125 administered by LVN F. *Midodrine was administered out of parameters on 4/18/2023 at 7:00 AM when the systolic blood pressure was 132 administered by LVN D. *Midodrine was administered out of parameters on 4/19/2023 at 7:00 AM when the systolic blood pressure was 140 administered by LVN D. *Midodrine was administered out of parameters on 4/20/2023 at 7:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 4/21/2023 at 7:00 PM when the systolic blood pressure was 126 administered by LVN A. *Midodrine was administered out of parameters on 4/25/2023 at 7:00 PM when the systolic blood pressure was 121 administered by RN E. *Midodrine was administered out of parameters on 5/03/2023 at 7:00 PM when the systolic blood pressure was 123 administered by LVN A. *Midodrine was administered out of parameters on 5/08/2023 at 7:00 AM when the systolic blood pressure was 122 administered by LVN D. *Midodrine was administered out of parameters on 5/14/2023 at 7:00 AM when the systolic blood pressure was 128 administered by LVN D. *Midodrine was administered out of parameters on 5/30/2023 at 1:00 PM when the systolic blood 675409 Page 9 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 pressure was 122 administered by LVN D. Level of Harm - Minimal harm or potential for actual harm *Midodrine was administered out of parameters on 6/01/2023 at 7:00 AM when the systolic blood pressure was 132 administered by LVN D. Residents Affected - Some *Midodrine was administered out of parameters on 6/07/2023 at 1:00 PM when the systolic blood pressure was 128 administered by LVN D. *Midodrine was administered out of parameters on 6/07/2023 at 7:00 PM when the systolic blood pressure was 126 administered by LVN A. *Midodrine was administered out of parameters on 6/20/2023 at 7:00 PM when the systolic blood pressure was 126 administered by LVN A. *Midodrine was administered out of parameters on 6/26/2023 at 7:00 PM when the systolic blood pressure was 124 administered by LVN A. *Midodrine was administered out of parameters on 6/29/2023 at 1:00 PM when the systolic blood pressure was 136 administered by LVN D. In an interview on 7/02/2023 at 1:30 PM, LVN G stated she reviewed medications prior to pulling them from the container or blister pack. LVN G stated she would obtain vital signs for the medications as per the PCP orders. LVN G stated midodrine is a medication that helps bring up blood pressure. LVN G stated the medication would be held if the blood pressure were too high. LVN G stated that a resident could have headaches or become hypertensive [high blood pressure] if midodrine were given to a resident when their blood pressure was high. LVN G stated she could not recall which residents received midodrine, she would need to review the MARs or Order Summary for each resident. In an interview on 7/02/2023 at 4:45 PM, LVN A stated midodrine is a medication that is given only to a few of the residents. LVN A stated midodrine is to help residents with low blood pressure. LVN A stated the PCP or pharmacist set the desired parameters. LVN A stated he would hold any medication if the residents' vital signs were out of the PCP's parameters. LVN A stated he could not recall any instance of administering medication out of parameters set by the PCP. LVN A stated he documented the reason code in the MAR when a medication was held or omitted. LVN A stated it was possible he incorrectly documented a medication as given, when the parameters indicated the medication should be held. LVN A stated he could not recall any residents that required midodrine ever having symptoms of high blood pressure after medication administration. LVN A stated he tried to accurately document in the moment, but sometimes the residents' behaviors could be distracting if they were violent, loud, or intrusive . In an interview on 7/02/2023 at 5:50 PM, the DON stated the symbol > indicated greater than and the symbol < indicated less than. The DON stated these symbols were used on the MAR when a medication has parameters to hold if the vital signs or blood sugars are either too high or too low for safe administration of a medication. The DON stated the PCP set the parameters for those medications. The DON stated midodrine was a medication that increase low blood pressure. The DON stated that midodrine should not be administered if the blood pressure or heart rate was already at specified levels as this could put the resident at risk for adverse effects such as stroke. The DON stated each nurse was trained to take the residents vital signs immediately prior to administering medications to the resident. The DON stated the MARs were reviewed each day prior to the morning meeting. The DON 675409 Page 10 of 11 675409 07/02/2023 Windsor Mission Oaks 3030 S Roosevelt Ave San Antonio, TX 78214

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated the MARs were reviewed to track refusals or non-compliance. The DON stated he had not realized midodrine was being given out of PCP established parameters. The DON stated he would have to further review the records for residents whose medications had parameters set by the PCP. Review of Medication Administration policy, dated 10/24/2022, revealed under the heading Policy Explanation and Compliance Guidelines, step 8. Obtain and record vital signs, when applicable or per physician orders. When applicable, hold medication for those vital signs outside the physician's prescribed parameters. In step 14. Administer medication as ordered . In step 17.record the vital signs on the MAR. 675409 Page 11 of 11