Failure to Follow Professional Standards in Medication Administration and Wound Care
Penalty
Summary
The facility failed to provide care and services in accordance with professional standards for two residents. For one resident with multiple diagnoses including diabetes mellitus, metabolic encephalopathy, and congestive heart failure, clinical records showed that blood glucose levels exceeded 400 mg/dl on two occasions. On one occasion, 14 units of aspart insulin were administered and the supervisor was notified, but there was no documentation that the physician was notified as required by the sliding scale insulin order. On the second occasion, there was no documentation that insulin was administered or that the physician was notified. Progress notes did not reflect any physician notification for either event, despite the physician order specifying this action. For another resident with muscle weakness and gait abnormalities, after sustaining a fall and a skin tear on the left lower arm, there was no documentation that the physician was notified or that treatment orders were obtained. The resident reported that the wound was not cleaned for three days and only rebandaged upon her request. Clinical records did not include any physician orders for treatment of the wound, and the DON confirmed that a standard order for dressing and treatment should have been in place.