Failure to Notify Physicians of Critically Elevated Blood Glucose Levels
Penalty
Summary
The deficiency involves the facility’s failure to notify physicians when residents’ blood glucose levels exceeded ordered parameters, despite existing policies requiring such notification. The facility’s Diabetes Policy and Guidelines for Notifying Physicians of Clinical Problems state that physicians will set parameters for blood sugar monitoring and that significant fluctuations in blood sugar require physician notification, with these parameters to be incorporated into the MAR and care plan. For one resident with type 2 diabetes, stroke, anxiety, and severe cognitive impairment, the care plan included monitoring for signs and symptoms of hyperglycemia and a physician order to call if blood sugar was over 450 mg/dL. Over the course of a month, this resident’s blood sugars were repeatedly recorded between 471 mg/dL and 598 mg/dL on multiple occasions, yet the medical record contained no documentation that the physician was notified. Another resident with a femur fracture, diabetes mellitus, and intact cognition had a care plan goal of no signs or symptoms of hyperglycemia and an order to call the physician if blood sugar exceeded 350 mg/dL. This resident’s blood sugars reached 481 mg/dL and 352 mg/dL on separate occasions, with no record of physician notification. A third resident with metabolic encephalopathy, cirrhosis of the liver, history of stroke, type 2 diabetes, and moderate cognitive impairment had an order to notify the physician if blood sugar was over 450 mg/dL; this resident’s blood sugar reached 456 mg/dL, again without documentation of physician notification. During interviews, the wound RN and the DON confirmed that the blood sugar parameters were current, that staff were expected to notify physicians for out-of-parameter readings, and that they could not find documentation that physicians had been notified for these elevated blood sugars.
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