Insulin Administered Too Early Before Meal
Penalty
Summary
A patient with diabetes mellitus, who was cognitively intact and required some assistance with daily activities, was prescribed insulin lispro to be administered subcutaneously 15 minutes before meals and at bedtime, according to a sliding scale based on blood glucose levels. On the day in question, the patient received 8 units of insulin lispro at 4:00 p.m. for a blood sugar reading of 301 mg/dL, prior to the scheduled dinner. The patient's care plan specified that diabetes medication should be given as ordered by the physician. Observation and interviews revealed that the insulin was administered significantly earlier than the prescribed time, as the patient had not yet received the dinner meal more than an hour after the injection. The nurse who administered the insulin stated that it could be given up to an hour before the meal and did not provide a snack to the patient before dinner, citing being busy with other tasks. Facility policy required medications to be administered as ordered and in accordance with manufacturer specifications, which was not followed in this instance.
Plan Of Correction
C900: T22 DIV5 ART3-72313(a)(2) Nursing Service - Administration of Medication Corrective action for resident found to have been affected by this deficiency. On 3/10/2025, DON assessed Patient 7 for any adverse reactions related to the early administration of insulin lispro. There was no change in condition noted. Identify any other residents who may have been affected by the deficient practice. On 3/12/2025, MRD audited the last 7 days of insulin administration to ascertain if any other patients had been given insulin before it was due. There were no other issues identified. Measures that will be put into place to ensure that this deficiency does not recur. Beginning 3/10/2025, in-servicing of licensed nurses regarding the proper timing and administration of insulin was initiated. (To continue page 5 of 25) continued Measures that will be implemented to monitor the continued effectiveness of the corrective action taken to ensure that this deficiency has been corrected and will not recur. Beginning 3/12/2025, MRD will spot check insulin administrations of 5 patients per week to ensure they are not being administered before they are due. These weekly audits will continue for 1 month or until substantial compliance is obtained. Any ongoing issues will be reported by MRD at the monthly QA meeting. Date of corrective action would be completed. 04/03/25 C 900