Failure to Administer Insulin and Monitor Blood Sugar per Physician Orders
Penalty
Summary
A deficiency occurred when a resident with type 1 diabetes mellitus did not receive appropriate insulin administration and blood sugar (BS) monitoring according to physician orders and facility policy. On one occasion, the resident's BS was found to be 541 mg/dL, but the prescribed dose of Humalog KwikPen insulin was not administered, and the physician was not notified as required. Additionally, there were multiple instances where the licensed vocational nurse (LVN) failed to check the resident's BS prior to administering insulin, and in one case, administered insulin based on a BS reading taken several hours earlier without rechecking the current level. The facility's policy required BS checks and physician notification for readings above 350 mg/dL, but these steps were not consistently followed. The resident's medical records indicated a history of type 1 diabetes and essential hypertension, with orders for both scheduled and sliding scale insulin. Documentation showed that the resident experienced a severe hypoglycemic event, with a BS of 25 mg/dL, resulting in unresponsiveness and transfer to the hospital. Despite this event, subsequent insulin administration and BS monitoring remained inconsistent. The LVN involved stated that fear of another hypoglycemic episode influenced the decision not to administer insulin when the BS was high, but this was not communicated to the physician in a timely manner. There were also discrepancies in the documentation of BS checks and insulin administration, with some doses given without recent BS readings and some high BS readings not followed by the required interventions. Interviews with staff and review of facility policies confirmed that the required protocols for diabetic care, including timely BS monitoring, insulin administration, and physician notification, were not adhered to. The director of nursing acknowledged that the nurse should have rechecked the BS before administering insulin and should have notified the physician of significant changes. The facility's policies emphasized the importance of monitoring and documentation, but these were not consistently implemented, leading to confusion among staff and inadequate care for the resident.