Failure to Notify Provider of Critically Elevated Blood Glucose Levels
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders and care plan parameters for notifying the provider when a resident’s blood glucose levels were outside the ordered range. A resident with diabetes mellitus, morbid obesity, and a history of stroke had an admission MDS showing intact cognition and daily insulin use, and the care plan directed staff to monitor blood sugars and notify the provider for readings less than 60 mg/dl or greater than 350 mg/dl. Physician orders documented blood glucose monitoring twice daily with instructions to call the doctor if levels were below 60 mg/dl or above 350 mg/dl. Review of the resident’s blood glucose records from July through February showed numerous readings above 350 mg/dl, including multiple values in the 360–400+ mg/dl range and one reading of 596 mg/dl. Despite these elevated readings, the resident’s progress notes lacked documentation of any provider notification for blood glucose levels over 350 mg/dl on the identified dates. During interviews, a CMA reported that CMAs performed the Accu-checks and stated there were no parameters for when to notify the nurse or doctor, adding that she notified the nurse only if blood sugar was under 100 mg/dl or over 185 mg/dl. An administrative nurse stated that nursing staff should notify the physician if the resident was symptomatic and that staff usually faxed the doctor if the blood sugar was over a certain level if the resident was not symptomatic, and that the nurse should document any fax or call and the physician’s response. The facility’s written notification parameters stated that licensed nursing staff are responsible for contacting the primary care provider anytime a resident develops a clinical problem requiring provider intervention, but this was not reflected in the documentation for this resident’s elevated blood glucose levels.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.