Failure to Honor Treatment Refusal and Provide Privacy During Blood Glucose Monitoring and Insulin Administration
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to refuse treatment and to receive care in privacy during blood glucose monitoring and insulin administration. Facility policies on resident rights state that residents have the right to make their own choices and to request, refuse, or discontinue any treatment, and the Medication Administration policy states that residents may actively refuse medications. The resident involved had multiple diagnoses, including cerebral infarction, dysphagia following cerebral infarction, hypertension, dementia without behavioral disturbance, psychotic disturbance, mood disturbance, anxiety, chronic kidney disease stage 3, and type 2 diabetes mellitus with hyperglycemia. On the date of the incident, the facility’s incident report documented that the resident was refusing to have her blood glucose level taken, yet an LPN took the resident’s hand and obtained the blood glucose level while the resident was refusing, and then administered insulin after the resident had stated she did not want it completed. The LPN stated she was doing what the resident’s POA wanted done. A CNA reported that at breakfast the resident refused the blood glucose check and insulin, and that after an RN left the dining room, an LPN returned and stated that the POA wanted the blood glucose checked and insulin given. The CNA stated the LPN pulled the cover back from the resident, checked the blood glucose using blood obtained from the resident’s finger, left, then returned with a syringe, again pulled the cover back, peeled up the resident’s sleeve, and administered insulin, all while the resident had refused. The CNA reported that the resident then looked at another CNA and stated that her rights were violated. The DON stated that staff should not perform cares or medical tests such as blood glucose monitoring or administer medications if a resident does not want it done, and that nurses should not be checking blood glucose levels or injecting medications such as insulin in the dining room, emphasizing that residents should be provided privacy for medication administration.
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