Failure to Follow Physician Orders and Medication Administration Standards for Diabetic Care
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards of practice for one resident with Type 2 diabetes mellitus and hyperglycemia. Specifically, the facility did not ensure that high blood glucose levels were rechecked as ordered after administering sliding scale insulin for glucose readings greater than 400. Multiple instances were identified where blood glucose levels exceeded 400, insulin was administered per sliding scale, but no evidence was found that glucose was rechecked after three hours as required by the physician's orders. Additionally, the facility did not consistently perform blood glucose checks to determine if sliding scale insulin was needed, as ordered, on certain mornings. There were also multiple occasions where the resident's blood glucose levels were above the threshold requiring physician notification, but there was no documentation that the physician had been notified as ordered. These failures were confirmed through review of the electronic medication administration records (eMAR) and nursing notes, as well as by the Director of Nursing during an interview. Furthermore, the facility did not administer the resident's prescribed morning doses of Lantus insulin on specific dates, as indicated by the absence of documentation in the eMAR. The Director of Nursing confirmed that there was no evidence these doses were given or documented. The facility's medication administration policy requires medications to be administered and documented as ordered, including timely administration, proper documentation, and physician notification when required, but these standards were not met in the care of this resident.