Failure to Notify Physician of Insulin Refusals
Penalty
Summary
The facility failed to notify a resident's attending physician about the resident's repeated refusals of insulin medication and requests to speak with the physician. The resident, who was cognitively intact and had a history of stroke and diabetes, was prescribed insulin lispro and insulin glargine. Despite the resident's refusals of these medications on multiple occasions, there was no documented evidence that the physician was informed of these refusals or the resident's request for clarification on insulin dosages. The resident refused her insulin doses on several dates in January and February, citing concerns about the dosage being too high. A nurse's note indicated that the physician was aware and would review the insulin and medications on rounds, but there was no documentation confirming that the physician addressed the resident's concerns. An interview with the Director of Nursing confirmed that the physician was not notified of the resident's continued refusals and requests for clarification, which should have been done.
Plan Of Correction
Resident 26 insulin orders were reviewed with the provider and adjustments were made to resident's insulin orders through collaboration with resident and provider. Baseline audit was completed on residents with insulin orders to identify other residents that are refusing insulin. The Director of Nursing provided education to licensed staff on notifying the provider when residents refuse insulin and documenting that the provider was notified. Monitoring will be captured through auditing insulin administration. Audits will be conducted on 4 resident records weekly for 4 weeks, then 8 resident records 2 times monthly for 2 months. The audits will be conducted by the Director of Nursing or designee. Results of the audits will be provided to the Administrator and be presented for review at the monthly Quality Assurance Improvement Committee (QAPI) meeting monthly for a period of three months. Any revisions to the audit plan will be reviewed and implemented with coordination of the interdisciplinary team at QAPI Committee meeting.