Failure to Monitor and Report High Blood Glucose in Diabetic Resident
Penalty
Summary
A deficiency occurred when a resident with a diagnosis of diabetes mellitus and multiple wounds did not receive appropriate blood glucose (BG) monitoring and management according to physician orders and facility policy. The resident had orders for BG checks four times daily but did not have any diabetic medications or insulin ordered, despite experiencing multiple high BG readings, some as high as 390 mg/dL. There were no parameters in the physician's orders specifying when to notify the provider about abnormal BG readings, and no documentation of nursing interventions or physician notifications for these elevated results. The resident expressed concern about not receiving insulin for high blood sugars, which she had previously managed independently at home and in the hospital. Nursing staff confirmed that high BG readings were recorded but not communicated to the medical doctor, and no interventions were documented. One nurse stated she consulted another nurse about whether to notify the physician but ultimately did not do so. The medical doctor was unaware of the resident's high BG levels and prior insulin use, and acknowledged that notification parameters and treatment orders should have been in place. Facility policy required nurses to notify physicians of BG levels outside the normal range and to document such communications. The Director of Nursing confirmed that high BG trends should have been reported to the physician and that monitoring parameters were necessary for resident safety. The lack of communication and absence of clear monitoring parameters led to the resident's high BG levels not being addressed, despite the known risk of delayed wound healing in diabetic patients.