F0684

J

Failure to Treat Critically Elevated Blood Glucose Levels in Diabetic Resident

Harlingen, Texas Survey Completed on 02-20-2026

Penalty

Fine: $92,510

Summary

The deficiency involves the facility’s failure to ensure that a resident with multiple diabetes-related diagnoses received treatment and care in accordance with professional standards of practice when experiencing significantly elevated blood glucose levels. The resident, an elderly female with Alzheimer’s disease, type 2 diabetes mellitus with multiple complications (including diabetic retinopathy, chronic kidney disease, cataracts, and peripheral angiopathy), and moderate protein-calorie malnutrition, had a care plan noting a history of diabetes and the need to monitor, document, and report signs and symptoms of hyperglycemia. Despite this, there were no physician or practitioner orders in place for routine glucose monitoring or blood sugar checks.

Laboratory results showed progressively elevated glucose levels over several days. A comprehensive metabolic panel on 02/04/26 showed a glucose level of 310 mg/dL, on 02/06/26 a level of 336 mg/dL, and on 02/13/26 a critically high level of 625 mg/dL. Nursing notes and the medication orders revealed that no new orders were requested or obtained for treatment of these high glucose levels, and there were no orders for glucose checks. Progress notes documented that lab results, including critical values, were communicated to the nurse practitioner on multiple occasions (02/05/26, 02/09/26, and 02/13/26), yet no new orders were issued to address the hyperglycemia.

Interviews confirmed that nursing staff and the nurse practitioner were aware of the elevated glucose levels but did not initiate treatment for hyperglycemia. LVNs reported that they had communicated the lab results to the nurse practitioner and received no treatment orders, and they did not make recommendations for treatment, stating they followed practitioner orders. The nurse practitioner acknowledged reviewing the labs, being aware of the increasing glucose levels, and focusing on hydration, weight loss, and a suspected infection, without placing new orders for the rising glucose. The DON stated that the resident was being treated for weight loss and other medical conditions, that no orders were received for high glucose levels, and that staff did not ask if anything should be ordered. The resident ultimately experienced an episode of high blood sugar over several days that led to hospitalization with a diagnosis including hyperglycemia.