Failure to Monitor and Record Fasting Blood Glucose for Insulin-Dependent Resident
Penalty
Summary
The facility failed to follow physician orders for a resident on insulin therapy by not monitoring and recording fasting blood glucose (FSBG) levels as directed. The physician's order, dated 5/20/25, specified that FSBG should be checked every morning. However, a review of the resident's chart revealed that no FSBG values had been recorded since the order was written. Interviews with the Infection Preventionist and a Licensed Vocational Nurse confirmed that the monitoring was not performed as required. Additionally, the resident reported being told by nursing staff that daily blood sugar monitoring was unnecessary. The facility's own diabetes protocol also indicated that blood glucose should be monitored twice daily for residents on insulin, further highlighting the deviation from both physician orders and facility policy.