Insulin Administered Outside Ordered Blood Glucose Parameters
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident’s insulin regimen was administered according to the provider’s parameters, resulting in the use of insulin when it was not ordered to be given. A cognitively intact resident with Type 2 DM, chronic kidney disease, moderate protein-calorie malnutrition, generalized muscle weakness, and sequelae of cerebral infarction had a physician order for 20 units of Insulin Glargine once daily unless the blood sugar was less than 110. The resident’s care plan indicated noncompliance with a therapeutic diet and directed that diabetes medications be given as ordered by the physician. Review of the MAR for a specified month showed that Insulin Glargine was administered on five occasions when the documented blood glucose levels were below 110, despite no evidence in the clinical record that the provider had authorized insulin administration when blood sugars were under that threshold. During interviews, a CMA stated that staff are expected to follow medication orders with parameters as written and that administering medications outside those parameters can overmedicate a resident and must be reported to the charge nurse and physician. The DON stated that insulin lowers blood glucose and that administering it outside prescribed parameters can cause hypoglycemia, and staff are expected to notify the provider when blood glucose values fall outside ordered parameters. A CNA reported being trained to perform finger-stick blood glucose monitoring, to notify the nurse immediately for low readings or signs of hypoglycemia, and to follow provider orders. The DON-by-proxy confirmed that documentation showed five instances where Insulin Glargine was given when blood glucose was below 110 and acknowledged that the expectation for medications to be administered in accordance with provider orders was not met. Facility policies on medication administration and MRR required holding medications when parameters are not met and obtaining clarification when there is any question about dosage, as well as identifying medication-related errors and unnecessary drugs.
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