Failure to Notify Physician of Medication Refusals and Held Insulin
Penalty
Summary
The facility failed to ensure that a physician was notified when a resident refused multiple critical medications and when long-acting insulin was held on several occasions. The resident in question had significant medical conditions, including type 2 diabetes mellitus with chronic kidney disease, a history of cerebral events, atrial fibrillation, congestive heart failure, hemiplegia, and hypertension. The resident also had severe cognitive impairment, as documented in the most recent assessment. On several documented dates, the resident refused to take all morning medications, including blood pressure, cardiac, and blood thinner medications, due to not wanting the medications crushed. There was no documentation that the physician was notified of these refusals. Additionally, the resident's long-acting insulin (Tresiba) was held multiple times due to varying blood glucose levels, but the medical record did not contain documentation of physician notification or clear parameters for when the insulin should be held. The facility's care plans required that medications be administered as ordered and that abnormal findings or refusals be reported to the medical provider, resident, or representative. Interviews with facility leadership confirmed that there should have been parameters for holding medications and that the physician should have been notified of both the medication refusals and the holding of long-acting insulin. The facility's policy also required notification of the physician and resident representative when there was a need to alter treatment, such as discontinuing or holding medications. The lack of documentation and notification in these instances constituted a failure to follow both physician orders and facility policy.