Failure to Follow Physician Orders for Sliding Scale Insulin Administration
Penalty
Summary
A deficiency occurred when the facility failed to follow physician orders regarding medication administration for a resident admitted with diagnoses including adult failure to thrive, muscle wasting and atrophy, acquired absence of the left leg above the knee, and muscle spasm. The resident was cognitively intact, as indicated by a BIMS score of 15. Upon admission, the resident had a physician order for Insulin Aspart Flex Pen to be administered before meals, with specific dosing instructions and a sliding scale for blood glucose management, as documented in the hospital discharge orders. Despite these clear orders, the facility did not create or administer the sliding scale insulin order until several days after admission. The Medication Administration Record (MAR) for the relevant month did not reflect the sliding scale insulin order or its administration until five days post-admission. Interviews with the Unit Manager and the Director of Nursing confirmed that the facility failed to implement the physician's sliding scale insulin order upon admission, and there were no documented changes to the insulin orders by the facility's physician during this period.