Failure to Ensure Nursing Staff Competency in Blood Glucose Monitoring and Insulin Administration
Penalty
Summary
The facility failed to ensure that nursing staff possessed the necessary competencies and skill sets to provide safe and appropriate care to residents, as evidenced by two specific incidents involving a registered nurse (RN). In the first incident, the RN delegated the task of checking a resident's blood glucose level to a certified nurse aide (CNA), despite facility policy and in-service training explicitly prohibiting CNAs from performing this task. The RN, who had prior experience in an acute hospital setting where CNAs were permitted to check blood sugars, was unaware of the restriction in the long-term care setting. The CNA, also previously employed in a hospital, was similarly unaware of the policy. The blood glucose check was performed by the CNA, and the RN subsequently administered insulin based on the result provided by the CNA. In the second incident, the same RN administered an insulin injection to another resident in the main dining room by injecting through the resident's shirt without cleaning the injection site. The RN admitted to this practice, stating that he was rushing and did not want to roll up the resident's sleeve in the dining room. The RN acknowledged that this was not in accordance with his training and recognized that the injection site should have been cleaned prior to administration. The incident was observed and reported by a restorative CNA, who noted that the resident was startled by the injection and that the site was not cleaned before the injection was given. Interviews and record reviews revealed that the facility did not have a skills checklist specific to insulin administration for licensed staff at the time of the incidents. Additionally, there was a lack of written documentation regarding the investigation and re-education of staff involved in these incidents. The facility's policy on medication administration required medications to be administered as ordered and in accordance with manufacturer specifications, which include proper site selection and cleaning prior to injection. The events described demonstrate that the RN did not follow established facility policies and procedures in both delegating tasks and administering injections.