Failure to Perform Ordered Blood Glucose Monitoring and Insulin Administration
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered blood glucose monitoring and insulin administration for a resident with known type 2 diabetes mellitus with hyperglycemia. The resident was admitted with dementia and diabetes, was cognitively impaired, ambulated with supervision, and was care planned for potential high and low blood sugar with interventions including diabetes medication and blood sugar checks as ordered by the physician. Physician orders directed administration of Insulin Glargine 40 units twice daily and Humalog per sliding scale at meals and at bedtime, along with monitoring for signs and symptoms of hypo- and hyperglycemia. Despite these orders, the Medication Administration Record shows that on multiple ordered times over two consecutive days, the resident’s blood sugar was not checked and Humalog was not administered. During this period, a progress note documented that the resident had been sleeping since the start of a night shift and continued to sleep a lot into the following day. An LPN later stated that the resident had exhibited behaviors and combativeness, then finally went to sleep and remained very sleepy, and that she did not check the resident’s blood sugars or give insulin because she felt sleeping was best for the resident at that time. The administrator stated an expectation that nurses monitor blood glucose levels as prescribed by the physician. The facility’s Blood Glucose Monitoring Policy in effect at the time required that blood glucose monitoring be performed for diabetic residents as per physician orders, but this was not followed for this resident during the identified time frame.
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