Failure to Follow Insulin Orders and Obtain Parameters for Holding Doses
Penalty
Summary
The deficiency involves the facility’s failure to administer insulin as ordered by the physician and to obtain physician parameters or orders for holding insulin doses for a resident with Type II diabetes mellitus. Resident B had a current signed order for Lispro insulin, 25 units subcutaneously with meals, dated 12/4/25, with no parameters for when to hold doses. The eMAR showed multiple instances where scheduled insulin doses were held without corresponding physician orders or documented parameters: the 7:30 a.m. dose was held on several dates for blood sugar (BS) values of 46, 90, and 116; the 11:30 a.m. dose was held on multiple dates for BS values ranging from 54 to 80; and the 5:30 p.m. dose was held on one date for a BS of 105. The clinical record also lacked documentation of any BS value, progress note, indication of the resident being out of the facility, or indication that insulin was administered for certain scheduled doses. The record further lacked documentation that the physician was notified regarding the held insulin doses. A QMA reported obtaining BS values prior to insulin administration and stated that, on one occasion when the BS was 77 at 11:30 a.m., the nurse instructed her to document in the eMAR that the insulin was held due to that BS value. During interview, the DON confirmed that the physician had not provided parameters for holding mealtime insulin, that the hospital discharge records did not include such parameters, and that the facility physician had not added any. The facility’s medication administration policy stated that if a dosage is believed to be inappropriate or excessive, or associated with potential adverse consequences, the person administering the medication will contact the prescriber or attending physician, but the documentation did not show that this occurred for the held insulin doses.
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