Failure to Follow Physician Orders for Insulin and Fluid Restrictions
Penalty
Summary
The facility failed to follow physician orders regarding insulin administration, blood sugar monitoring, and fluid restrictions for three residents. For one resident with chronic kidney disease, diabetes, heart disease, and dementia, there was a physician order for a daily fluid restriction of 2000 ml, with specific amounts allocated for each meal and shift. However, the Medication Administration Record (MAR) did not show any evidence of fluid monitoring as required by the order, which was confirmed by the Director of Nursing. Another resident had a physician order for Insulin Lispro to be administered according to a sliding scale, with instructions to notify the physician if blood sugar was below 70 or above 400. The MAR showed a blood sugar reading of 64, but there was no documentation that the physician was notified. A third resident had an order for Insulin Glargine to be held if blood sugar was less than 100, but the insulin was administered on multiple occasions when blood sugar was below this threshold. The Director of Nursing confirmed that the physician was not notified and that insulin was administered outside of the ordered parameters.