Failure to Notify Physician of Repeated Refusals of Diabetes Care
Penalty
Summary
Facility staff failed to notify a resident's physician of multiple refusals of blood glucose monitoring (accuchecks) and insulin injections on two consecutive days. The resident, who had diagnoses including Parkinson's disease, dementia, and type 2 diabetes mellitus, was moderately impaired in cognitive skills and dependent on staff for daily care. Physician orders required blood glucose checks and administration of insulin as per a sliding scale, as well as scheduled long-acting insulin injections. Documentation showed that the resident refused accuchecks and an insulin injection on several occasions, but these refusals were not communicated to the resident's physician as required by facility policy. Interviews with nursing staff confirmed that the refusals were not reported to the physician, and both the resident's primary physician and care coordinator stated they were not notified of the missed treatments. Facility policy specified that the attending physician should be notified after two or more consecutive refusals of treatment or medication, but this procedure was not followed in this case.