Failure to Monitor Blood Sugar in Diabetic Resident During Prolonged Fasting
Penalty
Summary
A deficiency occurred when the facility failed to obtain a blood sugar level by fingerstick for a resident with diabetes mellitus who had not eaten for over six hours. The resident, who also had severe cognitive impairment and was dependent on staff for most activities of daily living, pulled out his nasogastric tube (NGT), resulting in the inability to provide nutrition from 3 p.m. to 9:30 p.m. During this period, the resident's blood sugar was not monitored, despite the care plan indicating the need to monitor blood sugar as ordered and the facility's policy requiring blood glucose checks when fasting or after significant changes in condition. Interviews with two licensed vocational nurses confirmed that the resident's blood sugar was not checked during the fasting period, even though both nurses acknowledged the importance of monitoring for hypo- or hyperglycemia in such situations. The facility's policy and procedures for diabetes care specifically indicated the need to monitor blood glucose in cases of fasting or acute changes, but this was not followed in the resident's case.