Insulin Administered Prior to Meal in Violation of Physician Order
Penalty
Summary
A resident with a diagnosis of diabetes mellitus and an intact cognitive status, as indicated by a BIMS score of 15, was admitted to the facility and had an active physician's order for rapid-acting insulin aspart to be administered subcutaneously with meals according to a sliding scale. On the day in question, a licensed nurse checked the resident's blood sugar, which was 167, and administered 1 unit of insulin aspart before the resident had eaten lunch. Both the nurse and the resident confirmed that the insulin was given prior to the meal, and lunch was not served until later. Facility policy requires that medications, including insulin, be administered in accordance with physician orders and within specified time frames, particularly for medications ordered to be given with meals. The Director of Staff Development confirmed that staff are expected to follow physician orders for insulin administration and acknowledged that the insulin was administered too early, not in accordance with the order. The facility's policies on medication and insulin administration were reviewed and supported the requirement for timing insulin with meals.