Failure to Ensure Nursing Competency in Medication Administration and Monitoring
Penalty
Summary
Nurses and nurse aides at the facility failed to demonstrate the necessary competencies to provide safe care for a resident with diabetes mellitus type 2. The licensed nurses did not administer Glargine insulin as ordered over several days, failed to notify the physician about the missed doses, and did not communicate these omissions to the charge nurse. Additionally, the nurses did not clarify conflicting medication administration orders, resulting in medications being given by mouth despite an order for enteral administration via feeding tube. The Director of Nursing confirmed that the insulin was not given for multiple days and that the physician was not notified, attributing these failures to the inexperience of the nursing staff. The facility also failed to ensure that blood glucose monitoring orders were correctly entered and followed. The order for finger stick blood sugar (FSBS) monitoring did not appear on the Medication Administration Record (MAR), and as a result, no blood sugar monitoring was performed. The Director of Nursing acknowledged that the FSBS order was entered incorrectly and that the new nurses did not recognize the need to clarify or implement the order. One nurse admitted that inexperience was the reason for not clarifying the missing FSBS order with the physician. Documentation review revealed that the resident received multiple medications by mouth, despite orders indicating the need for enteral administration due to NPO status and enteral feeding. The Director of Nursing and a licensed nurse both confirmed that medications were administered orally without clarification from the physician. The resident ultimately required hospital admission for fluids and diabetes control following these failures in care.