Failure to Address Diabetic Management and Physician Notification for Wound Healing
Penalty
Summary
The facility failed to ensure that a physician assessment was completed and that changes in medical status were addressed in accordance with professional standards of practice for diabetic management to promote wound healing for a resident with diabetes and multiple wounds. The resident's care plan identified risks related to decreased mobility, incontinence, aged skin, peripheral vascular disease, and a history of diabetes. Despite repeated podiatry consults recommending blood glucose control below 180 mg/dL to promote wound healing, the resident's blood glucose levels were consistently elevated, with 39 out of 43 readings above the recommended threshold. Physician orders required notification for blood glucose levels below 70 or above 250, but the majority of readings were above 180, and several exceeded 250. There was no documented evidence that the physician was notified of the persistently elevated blood glucose levels, nor that any nutritional or pharmacological interventions were attempted or modified to address the hyperglycemia. The podiatry recommendations for optimal diabetic management were not addressed by the physician, and the resident's wounds worsened, ultimately resulting in hospitalization for wound infection and osteomyelitis. The Director of Nursing confirmed that the podiatry recommendations for diabetic management to promote wound healing were not addressed.