Failure to Provide Blood Glucose Monitoring Parameters and Physician Oversight for Diabetic Resident
Penalty
Summary
A deficiency occurred when the attending physician failed to provide blood glucose monitoring parameters and adequate oversight for a resident with a diagnosis of diabetes. The resident was admitted with a history of diabetes and wound care needs, and her medical record indicated orders for blood glucose checks four times daily. However, there were no specific parameters for managing high or low blood sugar levels, nor were there instructions for when to notify the physician. The resident reported not receiving a diabetic meal or insulin coverage for elevated blood sugars, despite experiencing blood glucose readings significantly above the normal range. Nursing staff confirmed that the resident had multiple high blood glucose readings, including values over 300 mg/dL, but there was no documentation of nursing interventions or physician notification in response to these abnormal results. The medical record and progress notes lacked any assessment or plan of care addressing the resident's diabetes management, and the physician was unaware of the resident's prior insulin use at home or in the hospital. The facility's policies required physician notification for abnormal blood glucose levels, but this was not followed. Interviews with staff, including the DON and the physician, revealed that there was an expectation for nurses to communicate high blood sugar trends and for monitoring parameters to be in place for resident safety. The lack of physician oversight and absence of clear orders for blood glucose management contributed to the resident not receiving appropriate diabetic care, as evidenced by the lack of interventions for high blood sugar and the absence of a diabetic diet or medication orders.