Failure to Align Diabetes Care Plans with Physician Orders
Penalty
Summary
The facility failed to develop and implement comprehensive care plans for two of three sampled residents with diabetes mellitus, as required by physician orders and facility policy. For both residents, the care plans included goals to maintain blood glucose levels within a specified range and interventions such as monitoring blood glucose and observing for signs of hypo- or hyperglycemia. However, neither resident had an active physician's order for routine bedside blood sugar monitoring, which was a key component of the care plan interventions. Resident 4 was admitted and readmitted with a diagnosis of diabetes mellitus type 2 and diabetic polyneuropathy. The resident's care plan specified blood glucose monitoring and maintaining levels between 70 and 150 mg/dl, but the order summary report showed no physician order for routine blood sugar checks. Interviews with nursing staff confirmed that the care plan called for monitoring, but this was not supported by physician orders. Similarly, Resident 6, who had severe cognitive impairment and required assistance with activities of daily living, had a care plan with similar goals and interventions for diabetes management. The order summary report for this resident also lacked a physician order for routine blood glucose monitoring or for monitoring signs and symptoms of hypo- or hyperglycemia. Nursing staff and the DON acknowledged the importance of care plans in guiding resident care, but the necessary physician orders to implement the care plan interventions were not present.