Failure to Revise Care Plan for Diabetic Management Refusals
Penalty
Summary
The facility failed to revise the care plan for a resident with diabetes mellitus type II and kidney failure to address her ongoing refusals of medications, insulin, and meals, which are critical components of her diabetic management. Multiple nursing progress notes documented the resident's repeated refusals of evening medications, blood glucose checks, and insulin administration over several months. The interdisciplinary team (IDT) was aware of these refusals and attributed some to the resident's delusions about contracting illness from sharing a room, but the care plan was not updated to reflect these behaviors or to implement new goals and interventions specific to her diabetic management challenges. The resident's care plan, dated several months prior, only addressed her risk for adverse effects of hyperglycemia and hypoglycemia related to her diabetes and use of glucose-lowering medication. Despite ongoing documentation of her refusals and the IDT's awareness of the issue, the care plan lacked any revisions to include her history of refusing medications, insulin, and meals. This omission was identified during a review of her medical record and care plan, as well as through interviews and observations conducted by surveyors.