Failure to Obtain Physician's Order for Blood Sugar Monitoring
Penalty
Summary
The facility failed to obtain a physician's order for blood sugar fingerstick testing for a resident with diabetes, despite the resident being admitted with a diagnosis of diabetes mellitus with hyperglycemia and an order for insulin administration. The resident reported that her blood sugar was not being checked upon admission until she informed staff of her diabetes, after which staff began checking her blood sugar before meals. The first recorded blood sugar result was over 300. A review of the resident's physician's orders confirmed there was no order for blood sugar checks, even though insulin was ordered and administered. Interviews with nursing staff and the nurse practitioner revealed that it was expected practice to have a separate physician's order for blood sugar fingerstick testing, and the facility's policy required such an order before performing the procedure. The care plan for the resident indicated that blood glucose checks should be performed as ordered, but no such order was present in the medical record. Staff acknowledged that a physician's order was necessary for both resident safety and compliance with facility policy.