Insulin Administration and Compression Stocking Orders Not Managed per Professional Standards
Penalty
Summary
The deficiency involves failure to ensure services met professional standards of quality for two residents. For one resident with diabetes, an LPN administered 5 units of Novolog, a fast-acting insulin, and 42 units of Toujeo, a long-acting insulin, when the resident’s blood glucose was 264 and before the resident had eaten breakfast. The LPN stated that after Novolog administration the resident should eat or drink within 20–30 minutes, and that staff were supposed to wake the resident, set up the room tray, and encourage eating. However, subsequent observations showed the resident remained asleep with an untouched breakfast tray at the bedside more than an hour after insulin administration, and the resident later reported that staff had not awakened her when the tray was delivered and that she had not eaten anything that day. A pharmacist and the DON both confirmed that food intake or blood glucose monitoring should occur within 20–30 minutes after Novolog administration, and the facility lacked an insulin administration policy. The second deficiency concerns failure to ensure a resident had a physician’s order in the EMR and on the TAR for compression stockings that staff were routinely applying. One resident was observed wearing bilateral compression stockings and reported staff put them on each morning to help with lower leg swelling. A CNA confirmed the resident was to wear bilateral compression stockings when out of bed for edema, but on a later observation the resident was not wearing them and stated staff had not applied them that morning. Review of the EMR showed prior and discontinued orders for TED hose, Ace wraps, and compression stockings, including an order to discontinue compression stockings after ankle measurements showed no change, and a later provider progress note referencing the resident going without compression stockings. There was no active physician order for compression stockings at the time staff were applying them, and the DON confirmed there should have been an order in the EMR and a corresponding treatment on the TAR. The facility did not have a policy regarding transcription and communication of physician orders to staff for implementation.
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.