Failure to Notify Physician of Insulin Refusals and Held Doses
Penalty
Summary
Staff failed to notify the physician when a resident's scheduled Novolog insulin was refused or held, as required by facility policy and physician orders. The resident, who had diagnoses of type 2 diabetes mellitus, schizoaffective disorder, and congestive heart failure, was cognitively intact and mostly independent in activities of daily living. The care plan directed staff to administer insulin as ordered and to notify the physician if blood glucose levels were not within specified parameters. Review of the resident's electronic medical record and medication administration records over several months showed multiple instances where the resident either refused the scheduled Novolog insulin or the medication was held due to vital signs being outside of parameters. Despite these occurrences, there was a lack of documentation in the progress notes that the physician had been notified of the refusals or held doses, except for a single note indicating the provider's office was notified of frequent refusals with no new orders received. No further notifications were documented after that point. Interviews with nursing staff and administrative nurses confirmed that the physician should have been notified each time the resident refused or the medication was held, especially since the insulin order did not include specific hold parameters. Facility policy required immediate notification of the physician and resident representative when there was a need to alter treatment significantly, such as discontinuing or withholding a prescribed medication.