Failure to Administer Insulin as Ordered and Inadequate Documentation
Penalty
Summary
The facility failed to administer insulin as ordered by the physician for one resident with type 2 diabetes mellitus, resulting in multiple missed doses of scheduled Humulin 70/30 insulin. Review of the resident's electronic medical record (EMR) revealed that the scheduled insulin was not administered on numerous occasions across several months, both in the morning and evening, without appropriate documentation or justification in the Medication Administration Record (MAR). In some instances, the insulin was held due to reasons not associated with the scheduled Humulin, such as blood sugar levels related to sliding scale insulin or the resident not having eaten, but these actions were not consistently documented or supported by physician parameters. Interviews with nursing staff and the Director of Nursing confirmed that the scheduled Humulin insulin should have been administered as ordered, and that holding the medication for reasons such as normal blood sugars or lack of appetite was not appropriate without physician direction. The Nurse Practitioner and other nursing staff stated that sliding scale insulin is intended to supplement, not replace, scheduled insulin doses, and that any concerns about blood sugar levels should be communicated to the provider rather than unilaterally withholding medication. The facility's policy on insulin administration also required verification and adherence to physician orders, with any discrepancies to be reported and documented. The resident involved was moderately cognitively impaired and expressed concern about the inconsistent administration of her diabetic medication, noting that nurses sometimes withheld her scheduled insulin when she did not eat well. The lack of consistent documentation and justification for missed doses, as well as the failure to follow physician orders and facility policy, constituted a significant medication error and a deficiency in medication administration practices.