Deficiency in Nursing Competency for Hypoglycemia Management
Penalty
Summary
The facility failed to ensure that licensed nurses demonstrated the necessary competencies and skills to provide appropriate nursing services for a resident with diabetes. The deficiency was identified when a resident, who had a history of coronary artery disease, chronic kidney disease, and diabetes, became unresponsive with a capillary blood glucose level of 59. Despite the resident's condition, a Registered Nurse administered only half a tube of glucose gel because the resident was not swallowing properly and sounded gurgling. The nurse then administered a glucagon injection, which only raised the blood glucose level to 65. Further investigation revealed that a Licensed Practical Nurse initially stated she would administer glucose gel to an unresponsive resident, which is inappropriate. Upon correction, she acknowledged that she would not administer glucose gel but also stated she would not provide any medication, indicating a lack of understanding of the proper protocol for treating severe hypoglycemia. The Director of Nursing confirmed the facility's failure to ensure that licensed nurses had the appropriate competencies and skills to provide necessary nursing services.
Plan Of Correction
Resident 11 was immediately assessed and orders reviewed by to ensure appropriate. The incident was reviewed by nursing administration. Resident R11's care plan and diabetic protocol orders were re-reviewed and confirmed to be accurate and appropriate for future hypoglycemic events. A clinical record audit was completed by DON/designee to identify residents with orders for emergency interventions (e.g., glucagon) to ensure that orders are clear for glucose gel vs. glucagon based on response level. A facility-wide mandatory in-service was conducted on by DON/designee for all licensed nurses, focusing on: - Recognizing signs and symptoms of hypoglycemia - When and how to administer glucagon - Contraindications for glucose gel (i.e., unresponsive residents) - Immediate documentation and provider notification DON/designee will conduct audit on all blood glucose out of range interventions to ensure correct treatment 5 times per week for 4 weeks, then 3 times per week for 2 weeks. All hypoglycemic episodes will be reviewed by the DON to ensure proper treatment selection based on the resident's responsiveness, documentation of actions taken.