Failure to Notify Physician of Insulin Refusal and Elevated Blood Glucose Levels
Penalty
Summary
The facility failed to notify the physician as required when two residents either refused prescribed insulin injections or experienced elevated capillary blood glucose (CBG) levels, as specified in physician orders and facility policy. For one resident with diagnoses including schizophrenia, anxiety disorder, seizure disorder, and type 2 diabetes mellitus, there were multiple documented refusals of prescribed Humalog insulin injections. However, the clinical notes did not indicate that the physician was notified of these refusals, contrary to facility policy and physician orders. For another resident with diabetes mellitus, hyperlipidemia, and PTSD, physician orders required notification if CBG levels exceeded certain thresholds. The resident's records showed several instances of CBG readings well above the specified threshold, but there was no documentation that the physician was notified of these elevated levels as required. The facility's policy on hyperglycemia management and the specific physician orders both mandated physician notification under these circumstances. Interviews with facility leadership confirmed that the nursing staff did not notify the physician as required, and instead relied on the nurse practitioner to review printed blood sugar records. The lack of timely physician notification for both medication refusals and elevated CBG levels constituted a failure to provide care and treatment according to physician orders and resident needs.