Failure to Follow Physician Orders and Obtain Notification Parameters for Blood Glucose Management
Penalty
Summary
The facility failed to ensure that services provided met professional standards of quality by not following physician orders related to blood glucose monitoring and physician notification for residents with diabetes. For one resident, there were multiple instances where blood sugar readings exceeded 300 mg/dl, as specified in the physician's sliding scale insulin order, but there was no documentation that the physician was notified as required. The Assistant Director of Nursing confirmed the lack of documentation for physician notification when blood sugars were outside the ordered parameters. Another resident had physician orders for blood glucose monitoring before each meal and a sliding scale for insulin administration, including instructions to notify the physician if blood sugar exceeded 350 mg/dl. However, documentation showed that blood glucose checks were not completed before supper, and there was no evidence that the physician order was changed to reflect this omission. The Assistant Director of Nursing stated that staff were expected to complete blood sugar checks before each meal as ordered. A third resident had an order for insulin administration before meals but lacked specific parameters for when to notify the physician of out-of-range blood glucose levels. On one occasion, the resident's blood sugar was documented as hypoglycemic at 57 mg/dl, and insulin was administered, but there was no documentation that the physician was notified. Interviews with nursing staff revealed inconsistent practices regarding when to notify the physician in the absence of specific parameters, and the Assistant Director of Nursing and Administrator both indicated that perimeter orders should be obtained and physician orders followed.