Failure to Follow Physician's Orders for Insulin Administration
Penalty
Summary
The facility failed to follow physician's orders regarding the administration of insulin for a resident with multiple diagnoses, including diabetes, Hodgkin lymphoma, and COPD. The resident had a physician's order for Insulin Lispro to be administered after meals only if blood glucose (BG) was above 270 mg/dL, but on one occasion, insulin was given when the BG was 212 mg/dL, contrary to the order. Additionally, there were standing orders for as-needed insulin administration if BG exceeded 400 mg/dL or 500 mg/dL, but the medication administration record (MAR) showed multiple instances where the resident's BG was above these thresholds and insulin was not administered as ordered. Staff interviews confirmed that the insulin was given when it should have been held and that as-needed orders for high BG levels were not followed. The corporate RN acknowledged the discrepancies and noted that the as-needed order may have been confusing to some nurses, suggesting a lack of clarification. The clinical record and MAR lacked evidence of compliance with the physician's orders for insulin administration, resulting in a failure to provide care as prescribed.