Failure to Provide Timely and Appropriate Care for Severe Hyperglycemia
Penalty
Summary
A resident with a history of diabetes mellitus due to pancreatectomy, and prior episodes of hyperglycemic-hyperosmolar coma, experienced a critical episode of hyperglycemia while under the care of facility staff. The resident, who uses a Dexcom continuous glucose monitor, reported a blood sugar reading exceeding 400 mg/dL to the assigned LPN during the evening. Despite repeated requests from the resident to have their blood sugar checked and to be sent to the emergency room, the LPN initially refused to check the blood sugar outside of scheduled times and dismissed the resident's concerns, instructing them to 'go sleep it off.' After persistent requests, the LPN checked the blood sugar, found it to be in the high 300s, but still refused to contact a physician or arrange for emergency care. The resident, experiencing symptoms such as headaches, blurry vision, nausea, and mental confusion, contacted their representative, who advised calling 911. Emergency medical technicians responded, found the resident's blood sugar to be 563 mg/dL, and transported the resident to the emergency department. The LPN did not provide the EMTs with any transfer documentation, including medical history, medication lists, or recent medication administration records, and stated that since the facility did not initiate the transfer, no paperwork would be provided. Upon arrival at the hospital, the resident was treated for severe hyperglycemia and received discharge instructions and new physician orders for regular glucose monitoring and as-needed insulin administration. Upon the resident's return to the facility, the EMT hand-delivered the hospital discharge instructions and new physician orders to the same LPN. However, the LPN failed to document the emergency department visit, did not enter or implement the new physician orders, and did not notify the resident's physician of the incident or the elevated blood sugar levels. The facility administration later confirmed that no documentation or discharge information was present in the resident's medical record following the incident, and that required notifications and documentation were not completed.