Failure to Safely Administer Insulin and PRN Acetaminophen
Penalty
Summary
The deficiency involves failures in safe medication administration, particularly with insulin and acetaminophen. For one resident with chronic kidney disease and diabetes who required extensive assistance with ADLs and received insulin injections daily, an LPN prepared a fast-acting insulin FlexPen by attaching a needle and injecting the insulin into the resident’s abdomen without priming the pen to remove air. The LPN later acknowledged that the insulin pen should have been primed and that she had forgotten to do so. She also confirmed that the insulin pen was considered good for 30 days after opening but admitted there was no documented open date on the pen and that she had not noticed the blank date label before administering the dose. A second resident, who had chronic kidney disease, diabetes, heart failure, and morbid obesity and was cognitively intact but dependent for most ADLs, also received fast-acting insulin via FlexPen three times daily with meals. During observation, the same LPN correctly primed the insulin pen and administered the injection into the resident’s abdomen. However, after administration, the LPN stated she did not know when the insulin pen had been opened because it was not dated and admitted she had not checked the date-opened label before giving the insulin. Facility nursing staff, including an RN and another LPN, later stated that insulin pens should not be used if the date opened is not documented and that such insulin should be discarded and replaced. A third resident with diabetes, partial paralysis, and non-traumatic brain dysfunction, who required varying levels of assistance with mobility and ADLs, had a care plan for chronic pain directing staff to administer pain medication as ordered and monitor pain on a 0–10 scale. The resident’s physician order included acetaminophen 650 mg every six hours as needed for mild pain, and the order was on hold and did not include use for fever. When this resident was observed to be lethargic in a wheelchair at the dining table, staff obtained vital signs and reported a temperature of 100.4°F. The LPN instructed a CMA to administer acetaminophen, and the CMA attempted to give two acetaminophen tablets, but the resident refused by pulling her head back and saying no, at which point the CMA stopped. The LPN later acknowledged it was not acceptable to use a medication for a reason not included in the physician’s order and admitted she did not know the acetaminophen order did not include use for fever.
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