Failure to Notify Provider of Repeated Diabetes Medication Refusals
Penalty
Summary
The facility failed to immediately notify a resident's physician when there was a significant need to alter treatment, specifically regarding repeated refusals of prescribed diabetes medications. The resident, an older male with diagnoses including type 2 diabetes, hypertensive heart disease, cerebral infarction, and moderate cognitive impairment, refused his prescribed insulin injections three times daily and his oral diabetes medication on multiple occasions over a period of nearly three weeks. Despite these refusals, there was no documentation that the provider was notified, nor was there evidence that the resident received education about the importance of medication compliance during this time. Record reviews showed that the resident's blood sugar levels fluctuated, with readings ranging from 110 mg/dL to 307 mg/dL, but the provider was only to be notified if levels exceeded 399 mg/dL. Interviews with nursing staff confirmed that the protocol required provider notification and documentation in the resident's chart when medications were refused, as well as education for the resident. However, staff interviews and documentation review revealed that these steps were not consistently followed, and the provider was not informed of the ongoing refusals until the day of the survey interview. Facility policies required that refusals and the reasons for them be documented, and that the provider be notified after two or more consecutive refusals. Despite these policies, the resident's repeated refusals were not communicated to the provider in a timely manner, and there was no documentation of education provided to the resident regarding the consequences of refusing diabetes medications.