Based on medical record review and interview, there was no documented evidence that the facility formulated and implemented an integrated plan of emergency care for a patient who presented with elevated blood pressure and was not responsive to emergency department medical interventions. This finding was evident in one (1) of one (1) medical record reviewed (Patient #1). Findings: Review of the medical record for Patient #1 identified: [AGE]-year-old female who presented to the Emergency Department (ED) on 12/12/16 at 2:46 PM with complaint of left facial pain for four (4) days. The patient had a past medical history for asthma, [DIAGNOSES REDACTED] and hypertension. The patient's vital signs recorded at the 2:51 PM Triage were Blood Pressure (BP) 192/94 (normal range less than 120/80), Temperature 98.1F (average body temperature 98.6), Pulse 72 (normal range 60-100), Respirations 16 (normal 12-16), Pain Scale was 4 on a scale of 1 to 10. The medical physical assessment on 12/12/16 at 4:29 PM, noted; the patient with a past medical history of [DIAGNOSES REDACTED][DIAGNOSES REDACTED] and the medical plan documented, "Headache, facial pain, blurry vision- CT Scan brain, Steroids, Pain meds and likely need eye consult. There was no documented plan by the physician to address the patient's abnormal blood pressure. The CT Scan brain was completed at approximately 12/12/16 at 5:35 PM and on 12/13/16, approximately at 12:50 PM, Ophthalmology Consult was documented. The CT brain revealed no acute intracranial pathology and no hemorrhage. On 12/12/16 at 8:00 PM, Nurses Note documented, "received patient resting on stretcher. Alert and Oriented. Reports continued left face and ear pain. No shortness of breath. Continue to monitor." There is no documented evidence of monitoring, including BP. On 12/12/16 at 11:18 PM, approximately eight hours after initial presentation to the ED, the patient was noted to have blood pressure of 210/123 and at 11:30 PM the nurse noted, "Patient with elevated blood pressure, MD aware and will continue to monitor." There was no documented evidence that the physician was aware and implemented a medical plan to address the increasing blood pressure. On 12/13/16 at 2:40 AM, Nurses Note documented, "medicated for continued elevated blood pressure. Patient resting on stretcher, in no apparent distress. Continue to monitor." There is no documented evidence of monitoring, including blood pressure. On 12/13/16 at 4:08 AM, Nurses Transfer Note documented, "B/P 210/123." On 12/13/16 at 5:00 AM, Nurses Note documented, "vital signs, Blood Pressure 211/120, Heart Rate 74, Respiration 18, Temperature 97.4 F, medicated for continued elevated BP. Patient is cleared for admission, however patient is refusing admission until she speaks with consulting Ophthalmology. Medical Doctor made aware." On 2/13/16 at 7:36 AM, the patient's blood pressure was 226/121. On 2/13/16 at 9:30 AM, blood pressure was 220/142 with a repeat blood pressure at 9:31 AM of 190/142. There was no documentation that the medical care plan was revised to address the patient's increased blood pressure On 12/13/16 at 12:01 PM, the nurse notes, "Patient taken to SBH Opth, Clinic via wheelchair. No signs of distress noted." On 12/13/16 at 1:58 PM, Physician (Resident) documented the History and Physical (H&P), noting that the patient was admitted . The documented noted that the patient was seen in the eye clinic while waiting for transfer back to the ED. At the time of the assessment, the patient complained of severe headache, and pain on the right temple with no improvement of vision after steroids, patient states this episode has been worse than others have. The patient was admitted under the impression of possible [DIAGNOSES REDACTED] versus central retinal vein occlusion versus hypertensive emergency. The plan included treatment for hypertensive emergency: restart home medication, titrate BP down at timely fashion with extra doses of clonidine, will monitor BP. On 12/13/16 approximately 3:55 PM, it was determined that the patient had apparently walked out of the clinic. At approximately 4:31 PM on 2/13/16, the patient returned to ED via EMS, from a location outside the hospital, with increasing head pain and blood pressure of 218/126 at triage. The patient was placed on monitor and Neurology Consult called. Patient was successfully intubated, sedated and her condition was monitored and reassessed. The repeat CT scan showed acute intraventricular hemorrhage. There was no documented evidence of the monitoring and reassessment of the patient's blood pressure provided during the hours the patient was initially in the ED on 12/12/16 from 2:46 PM, to 12/13/16 approximately 2:00 PM. These findings were confirmed with Staff A, Medical Director of Emergency Services on 2/1/17 at 1:30 PM. Staff A stated, "The physician could have had better follow-up to the initial spike in blood pressure. The documentation was terrible and there was nothing documented by the physician before allowing the patient to leave for the clinic."