Untimely Blood Glucose Monitoring and Insulin Administration for Diabetic Resident
Penalty
Summary
The facility failed to ensure professional standards of quality care were met for a resident with type 2 diabetes mellitus when ordered blood sugar monitoring and insulin administration were not performed in a timely manner. The resident’s care plan identified a risk for hyperglycemia related to diabetes and included interventions such as education on medications, performing finger stick blood sugars (FSBS) as ordered with regular insulin, and following MD orders for a new insulin regimen/sliding scale. The MAR for the month showed that the resident’s blood sugar levels and insulin administration were scheduled for 7:30 AM and 5:00 PM daily, with a sliding scale order for insulin lispro based on blood sugar readings. However, documentation revealed that on multiple dates the resident’s elevated blood sugars were treated with insulin significantly later than the scheduled time, including administration at 9:37 AM and 9:18 AM instead of at the scheduled 7:30 AM time. During interview, the resident reported having to wait a long time to receive medications and stated that when she requested medication, staff would acknowledge the request but then appeared to forget once they left the room. The DON confirmed that it was her expectation that medications be administered within one hour before or after their scheduled time and acknowledged that breakfast was provided to the resident at 7:30 AM daily. Facility policy on administering medications required that medications be given in a safe and timely manner, within one hour of the prescribed time, and based on resident need and benefit rather than staff convenience. The facility’s insulin administration policy and manufacturer information for insulin lispro specified that rapid-acting insulin should be administered within 15 minutes before or immediately after a meal, underscoring that the late administration times documented on the MAR did not align with these standards or the resident’s ordered regimen.
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