Failure to Notify Physician of Critically Elevated Blood Glucose Levels
Penalty
Summary
The deficiency involves the facility’s failure to follow a physician’s order and notify the physician when a resident’s blood sugar (BS) exceeded 250. The resident had Type 1 diabetes mellitus with hyperglycemia and physician orders for Insulin Degludec to be administered subcutaneously twice daily, with instructions to hold the insulin if BS was less than 90 and to notify the MD if BS was greater than 250. Review of the Medication Administration Record for the month showed multiple BS readings above 250, including values of 330, 342, 341, 301, 383, and 299 while the resident was on a 23-unit twice-daily dose, and subsequent readings of 335, 372, 252, 257, 325, and 324 after the dose was changed to 28 units twice daily. The resident’s care plan documented that the resident had diabetes mellitus and directed staff to administer Insulin Degludec as ordered and to monitor, document, and report signs and symptoms of hyperglycemia to the MD as needed. During an interview and concurrent record review with the DON, the facility was unable to provide documentation that the MD had been notified of any of the BS results above 250. The DON stated that the nurses should have notified the MD when the BS result was above 250, consistent with the physician’s order. The facility’s undated policy and procedure for Blood Glucose Monitoring stated that it is the policy of the facility to perform blood glucose monitoring for diabetic residents as per physician’s orders and to report critical test results to the physician in a timely manner. Despite these orders and policies, there was no documentation that the physician was notified of the elevated BS values identified in the resident’s record review.
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