Failure to Administer and Document Insulin for Diabetic Resident
Penalty
Summary
A deficiency occurred when a resident with diabetes, hypertension, and Parkinson's disease did not receive prescribed insulin and blood sugar checks as ordered. The resident's Minimum Data Set indicated insulin dependence, and the Medication Administration Records (MARs) showed orders for blood sugar checks and Novolog insulin administration three times daily. On two separate occasions, the MARs lacked documentation and staff initials for both insulin administration and blood sugar checks during evening shifts. Progress notes also did not indicate whether the resident received or refused insulin on those dates. Interviews with staff revealed that the DON discussed documenting a refusal for insulin, although staff accounts and the resident indicated that the insulin was not administered and the resident was upset about missing a dose. The DON stated that refusals should be documented with reasons and the physician notified, but there was no documentation to support that this process was followed. The facility's policy required accurate recording of physician orders and avoidance of medication errors, which was not adhered to in this instance.