Failure to Update Care Plan After Discontinuation of Insulin
Penalty
Summary
The facility failed to revise the care plan to reflect a resident's current diabetes management status after a significant change in treatment. A resident with a diagnosis of Type 2 Diabetes Mellitus and a history of long-term insulin use was admitted with orders for both long-acting and rapid-acting insulin. On a later date, all insulin orders were discontinued by the physician. Despite a care plan meeting attended by the resident and the discontinuation of insulin, the care plan was not updated to reflect this change, and there was no documentation that the resident received education or information regarding the rationale for stopping insulin. The care plan continued to list the resident as insulin dependent and did not address the new approach to diabetes management.