Failure to Obtain and Follow Physician Orders for Insulin Administration and Catheter Use
Penalty
Summary
The facility failed to obtain and follow physician orders for two residents, resulting in deficiencies in medication administration and device management. For one resident with diabetes mellitus and other comorbidities, staff held fast-acting insulin on multiple occasions without physician-specified parameters or directives. The care plan did not include instructions for insulin use, and there was no documentation that the physician was notified when insulin was withheld. Nursing staff used their own judgment to decide when to hold the insulin, despite the absence of established blood glucose parameters from the physician. Another resident returned from a hospital stay with an indwelling urinary catheter following surgery for a foot fracture. Although the hospital communicated that the resident would return with a catheter, the facility did not obtain a physician order for the device upon readmission. Progress notes documented the presence and function of the catheter, but the clinical physician orders lacked any reference to it. The facility's policy required physician orders for all care and services, including medical devices, but this was not followed in the case of the catheter. Interviews with staff, including the DON and administrator, confirmed that there were no established parameters for holding insulin and that an order for the catheter was not in place prior to the survey. The administrator acknowledged that orders and diagnoses should be entered promptly and that routine orders, especially for catheters, were lacking at the time of the survey.