Failure to Notify Physician of Medication Refusal and Delayed Insulin Administration
Penalty
Summary
The facility failed to notify a resident's physician of the resident's refusal of dialysis medication and the late administration of sliding scale insulin. The resident, who had diagnoses of end stage renal disease, dependence on renal dialysis, and diabetes, was prescribed Sevelamer to be taken with meals and insulin Lispro per sliding scale. On the day in question, the resident refused Sevelamer at breakfast and was not offered the medication at lunch, yet the Certified Medication Technician (CMT) documented that the medication was given at both meals. The CMT did not inform the charge nurse of the refusal or omission, despite knowing the importance of the medication and the requirement to report such incidents. Additionally, the Agency Registered Nurse (RN) did not perform the resident's lunch time blood glucose monitoring or administer the sliding scale insulin after lunch, and did not communicate this to anyone. The Medication Administration Record (MAR) indicated that the insulin was administered later in the afternoon, but there was no documentation that the physician had been notified of the delay. Interviews with facility staff, including the Nurse Unit Manager and Director of Nursing, confirmed that the physician was not notified of the missed or refused medications, and that proper documentation and communication protocols were not followed.