Failure to Prime Insulin Pen Prior to Administration
Penalty
Summary
A deficiency occurred when a registered nurse failed to properly administer insulin to a resident with type 2 diabetes mellitus and multiple other diagnoses, including hypertension and peripheral vascular disease. The resident had a physician's order for Humalog (Insulin Lispro) to be administered subcutaneously before meals according to a sliding scale based on finger-stick blood sugar (FSBS) results. During a medication administration observation, the nurse checked the resident's blood sugar, which was 238, and prepared to administer three units of insulin as ordered. However, the nurse did not prime the insulin pen prior to dialing the dose and administering the medication. Interview with the nurse confirmed that the insulin pen needle was not primed before use, and the nurse was uncertain about the specific priming instructions. Review of the manufacturer's instructions for the Insulin Lispro KwikPen indicated that the pen should be primed with two units before administration to ensure accurate dosing. The facility's policy required medications to be administered according to physician orders and manufacturer instructions, but this was not followed in this instance, resulting in the resident potentially receiving an incorrect dose of insulin.