Failure to Hold Insulin per Physician Order for Blood Sugar Parameters
Penalty
Summary
A deficiency occurred when a resident with diagnoses including diabetes mellitus, traumatic brain injury, and dementia was not provided care according to the physician's orders and the established plan of care. The physician's order specified that Humalog insulin, 3 units subcutaneously before meals, should be held if the resident's blood sugar was less than 150 mg/dl. Despite this, the Medication Administration Record (MAR) documented multiple instances where the insulin was administered even though the resident's blood sugar was below the specified threshold. There was no documentation indicating that the insulin was held as ordered on these occasions. The care plan for the resident included an intervention to administer diabetes medication as ordered by the physician. The facility's policy on medication administration also required medications to be held if vital signs were outside the physician's prescribed parameters. During interviews, the Director of Nursing Services confirmed that the resident received Humalog when blood sugar was less than 150 mg/dl, contrary to the physician's order. The clinical record lacked documentation to support that the medication was withheld as required.