Failure to Provide Required Care for Alcohol Withdrawal and Diabetes Management
Penalty
Summary
The facility failed to provide all necessary care and services for a resident admitted with multiple right rib fractures and alcohol dependence with withdrawal. Upon admission, the resident was prescribed a Librium taper to manage alcohol withdrawal symptoms, but the facility was unable to provide the medication as it was not stocked and the resident did not bring it from the hospital. Instead, the resident was given Ativan, but his withdrawal symptoms persisted, including agitation, tremors, delusions, and aggressive behaviors. The resident was hospitalized three times due to these unmanaged symptoms, and staff reported feeling unprepared and untrained to care for residents experiencing withdrawal. Interviews with staff and review of care plans confirmed that no additional education or resources were provided for managing alcohol withdrawal, and the facility lacked an alcohol withdrawal assessment protocol. Another deficiency was identified in the management of diabetes and hypoglycemia for a resident with a primary diagnosis of diabetes mellitus. The resident experienced multiple episodes of low blood glucose, with documented readings below 70 mg/dL on several occasions. Despite these low readings, there were no progress notes, no evidence of physician notification, and no documentation of follow-up interventions or repeat blood glucose checks until levels normalized. The facility's policy required immediate follow-up and physician notification for blood glucose results below 70 mg/dL, but this was not followed in practice. Interviews with the DON confirmed the expectation that nursing staff should document communication with the physician, interventions taken, and repeat blood glucose monitoring for hypoglycemic events. However, the medical record review showed a lack of compliance with these expectations, as there was no documentation of appropriate actions taken in response to the resident's hypoglycemic episodes. The failure to follow established protocols and provide necessary care contributed to the deficiencies cited during the survey.