Failure to Administer Ordered Insulin and Perform Blood Glucose Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to administer ordered subcutaneous insulin and perform ordered blood glucose monitoring for a resident with dementia and Type 2 diabetes mellitus with hyperglycemia. The resident’s MDS documented cognitive impairment and insulin use, and the care plan identified a potential for high and low blood sugar with interventions including diabetes medications and blood sugar checks as ordered by the physician. The MAR for the month showed a physician’s order for Insulin Glargine 40 units twice daily that was not administered on three documented occasions, and a Humalog sliding scale insulin order before meals and at bedtime that was not administered on multiple documented occasions over two consecutive days. Additionally, the MAR documented an order for blood glucose monitoring before meals and at bedtime that was not completed at several scheduled times during the same period. A progress note later documented that staff were called to the resident’s room by a CNA at the request of the resident’s daughter, who reported the resident was clammy. Vital signs were recorded as 97.0, 74, 14, and 90/70, and an initial blood glucose check showed a reading of 230. The note stated the resident was unable to be aroused and had shallow breathing, and when the nurse voiced concern about the breathing pattern, the daughter stated that was how the resident breathed when sleeping. A subsequent progress note documented that a second blood glucose check at that time read “HI.” The Administrator stated she would expect insulin to be given as ordered, and the facility’s Medication Error Policy stated that medications shall be administered according to physician’s orders.
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