Failure to Follow Physician Orders for Blood Glucose Monitoring and Insulin Administration
Penalty
Summary
The facility failed to follow physician orders regarding blood glucose monitoring and insulin administration for a resident with diagnoses including type 2 diabetes mellitus, COPD, hypertension, and anxiety. Specifically, staff did not notify the physician when the resident's blood sugar readings were outside the ordered parameters on multiple occasions, as required by the physician's order. Additionally, the resident received insulin doses when her blood sugar was below the threshold specified in the physician's order to hold the medication. These actions were confirmed through review of the electronic medical record, medication administration records, and staff interviews. The resident's care plan and physician orders directed staff to perform blood glucose checks as ordered, notify the physician if readings were below 70 mg/dL or above 400 mg/dL, and to hold Lantus insulin if blood sugar was less than 120 mg/dL. Despite these directives, documentation showed several instances where low blood sugar readings were not reported to the physician and insulin was administered when it should have been withheld. Staff interviews confirmed awareness of the orders and the expectation to follow them. The facility was unable to provide a policy for medication administration upon request.