Failure to Administer Insulin According to Physician Orders and Facility Policy
Penalty
Summary
A deficiency occurred when a resident with diagnoses including Parkinson's Disease, Type 1 and Type 2 Diabetes Mellitus, and an acquired absence of the right leg below the knee did not receive prescribed insulin medications according to physician orders and facility policy. The resident, who had intact cognition and required insulin therapy, did not receive the scheduled 8 AM dose of Insulin glargine until after 11 AM. Additionally, the resident's Lispro insulin, which was ordered to be administered 15-20 minutes before meals, was not given as directed, and the 8 AM dose was held without a physician order. The resident also did not have a blood glucose check or receive insulin prior to breakfast as required. The sequence of events began when the resident, who typically got up around 5:30 AM, was not out of bed until around 9 AM for reasons that were unclear. The LPN responsible for medication administration had to leave the facility for approximately 15 minutes, and the Director of Nursing (DON) was unable to cover the medication cart due to other responsibilities. As a result, the resident's morning medications, including insulin, were significantly delayed. When the LPN returned, the resident's blood glucose was found to be 300, and the LPN administered the long-acting insulin and made decisions regarding the short-acting insulin without timely physician consultation or adherence to the special instructions for administration relative to meals. Documentation reviewed by the surveyor confirmed that the insulin doses were either late, held without a physician order, or not administered according to the specified timing in the orders. The facility's medication administration policy required medications to be given within one hour of the prescribed time and for any deviations to be documented and communicated appropriately. The DON was unable to explain why the Lispro was marked as held and then given at noon, or why the special instructions for timing with meals were not followed. No additional information was provided to clarify the rationale for these actions.