Failure to Notify Physician of Critical Blood Sugar Refusal and Elevated Glucose
Penalty
Summary
The facility failed to notify the medical doctor when a resident with multiple complex diagnoses, including type 2 diabetes mellitus, hypertension, gastrostomy, and chronic kidney disease, refused a fasting blood sugar (FSBS) check and subsequently had a critically elevated blood glucose reading. The resident, who lacked capacity to make healthcare decisions, was admitted with orders for regular FSBS monitoring and specific instructions to notify the physician if blood sugar exceeded 250 mg/dL. On the morning in question, the resident refused the FSBS at 6 a.m., and this refusal was not communicated to the physician as required by both facility policy and physician orders. Later that day, the resident was found to have a blood glucose level of 379 mg/dL and was noted to be difficult to arouse, with vital signs indicating hypotension. Despite the elevated blood sugar and the physician order to notify for readings above 250 mg/dL, staff did not contact the physician at that time. Instead, emergency services were called when the resident became unresponsive, and the physician was only notified after the resident was being transported to the hospital. Documentation was lacking regarding both the refusal of the FSBS and the missed insulin dose, and there was no evidence that the physician was informed of these events in a timely manner. Interviews with nursing staff and facility leadership confirmed that the physician should have been notified immediately of the resident's refusal and the subsequent high blood sugar, as per facility policy and standard practice. Staff acknowledged that failure to notify the physician could result in a delay of care. The facility's policies on medication administration, diabetic care, and blood glucose monitoring all require prompt physician notification for refusals and for blood sugar readings outside specified parameters, but these procedures were not followed in this case.