Failure to Ensure Nurse Competency in Medication Administration
Penalty
Summary
The facility failed to ensure that a registered nurse (RN) had completed the necessary competencies to administer ordered medications, resulting in a resident with type 2 diabetes not receiving a required dose of insulin. The resident had a physician's order for Humalog insulin to be administered according to a sliding scale based on blood sugar readings. On one occasion, the resident's blood sugar was 229, requiring 4 units of insulin, but the dose was not given. The RN documented that the insulin was not available in the facility at the time. Later that evening, when the resident's blood sugar was higher, another nurse informed the RN about the availability of emergency stock insulin, which was then administered as ordered. Interviews revealed that the RN was new to the facility and was not aware of the emergency stock medications during orientation. The orientation checklist was incomplete, not signed by trainers or the orientation coordinator, and did not include emergency medication access. The facility's policy required staff to have appropriate competencies, including medication management, but the competency checklist for the RN was blank and did not address emergency stock medications. The DON acknowledged the gaps in the orientation and competency process.