Failure to Rotate Insulin Injection Sites for Two Residents
Penalty
Summary
Licensed nursing staff failed to rotate subcutaneous insulin injection sites for two residents who were prescribed insulin for diabetes management. For one resident, medical records showed repeated administration of insulin in the same areas, such as the left lower quadrant of the abdomen and the right arm, over multiple days. The resident had diagnoses including type 2 diabetes mellitus, muscle weakness, and mild protein-calorie malnutrition, and was cognitively intact and able to make medical decisions. The order summary for this resident specifically instructed staff to rotate injection sites, but documentation revealed that this was not consistently done. For the second resident, who had type 2 diabetes mellitus with chronic kidney disease and mild protein-calorie malnutrition, similar failures were observed. The resident's records indicated that insulin was administered multiple times in the same area, such as the right or left arm and the abdomen, without proper rotation as required by the physician's orders. This resident had moderately impaired cognition and was also prescribed a sliding scale insulin regimen that included instructions to rotate injection sites. The care plan for this resident included an intervention to administer medications as ordered, but the rotation of injection sites was not consistently documented. Interviews with the Director of Staff Development and the Assistant Director of Nursing confirmed that licensed staff did not always rotate insulin administration sites for these residents. Both staff members acknowledged that site rotation is necessary to prevent complications and that the facility's policy and the prescribing information for Novolog insulin require rotation of injection sites. The facility's policy also outlined the main sites for insulin injection and emphasized the importance of rotating within those areas.