Failure to Monitor for Adverse Effects of Insulin and Diuretic Medications
Penalty
Summary
The facility failed to ensure adequate monitoring for residents receiving insulin and diuretic medications, as required by their own policies and regulatory standards. For one resident with diabetes who was prescribed routine insulin injections, there was no documentation in the physician’s orders, Medication Administration Record (MAR), or care plan indicating monitoring for hypoglycemia or hyperglycemia. Interviews with nursing staff and the Director of Nursing confirmed that such monitoring was expected but not performed or documented. Two other residents were prescribed diuretic medications for conditions such as edema and congestive heart failure. For both, the MAR, Treatment Administration Record (TAR), and care plans lacked evidence of monitoring for adverse side effects related to diuretic use, such as dehydration or changes in edema status. Staff interviews revealed that monitoring for these side effects was expected, but records did not show that it was carried out or documented. The facility’s policy required monitoring for side effects or adverse drug reactions immediately after administration and throughout each shift. Despite this, the records and care plans for the affected residents did not reflect the required monitoring for either insulin or diuretic therapy. Staff acknowledged during interviews that the expected monitoring was not documented or included in the care plans for these residents.