Lack of Physician-Ordered Blood Glucose Parameters for Insulin-Dependent Diabetic Resident
Penalty
Summary
Surveyors identified a deficiency related to unnecessary drugs and inadequate blood glucose management for one resident with diabetes mellitus. The resident had a diagnosis of diabetes, was cognitively intact with a BIMS score of 13, and was dependent on staff for toileting hygiene, mobility, and transfers. The MDS documented that the resident received insulin daily, and the care plan directed staff to provide a nighttime protein snack to keep blood sugars even, but the care plan did not include specific directions related to diabetes management. A physician order directed staff to obtain blood sugars before meals and at bedtime, yet the medical record lacked any physician-ordered blood sugar parameters. During interviews, a licensed nurse confirmed that there were no blood sugar parameters for the resident and stated he relied on his own nursing judgment to decide when to notify the physician if blood sugars seemed too high. A CMA reported that she did not know what the resident’s blood sugar parameters should be and stated that parameters had existed in a previous computer system but were absent in the new system. An administrative nurse acknowledged that the resident should have physician-ordered blood sugar parameters and that the care plan should provide direction to staff regarding the resident’s diabetes. When requested, the facility was unable to provide a policy for blood sugar management.
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