Failure to Follow MD Orders for Elevated Blood Glucose Notifications
Penalty
Summary
The deficiency involves the facility’s failure to implement a person-centered care plan and follow physician orders for blood glucose monitoring and MD notification for a resident with Type 2 Diabetes Mellitus and related complications. The resident had diagnoses including Type 2 Diabetes Mellitus with diabetic polyneuropathy, other hypoglycemia, unspecified severe protein-calorie malnutrition, and long-term use of insulin. The resident’s care plan included problems related to following MD orders and diabetes management, with interventions such as administration of Humalog insulin per sliding scale and diabetes medications as ordered, and monitoring for side effects and effectiveness. Physician orders directed staff to administer Humalog per sliding scale and to notify the MD when blood glucose levels were above specified thresholds (greater than 350 or 351 mg/dL), and later to monitor blood glucose four times daily and call the MD if levels were less than 70 mg/dL or greater than 350 mg/dL. Record review of the MARs and nursing notes showed multiple documented elevated blood glucose readings above the ordered notification thresholds on several dates, with no corresponding documentation that the physician was notified. Specific readings included values in the 370s and 390s on multiple occasions, and later readings of 367 mg/dL, all without evidence of MD notification in the MAR or nurses’ notes. In interviews, the involved LPNs acknowledged that they did not notify the physician despite the orders to do so and confirmed that such notifications should have been documented. The ADON, DON, and NP each confirmed that, based on the physician orders, nursing staff were expected to notify the provider when blood glucose exceeded the ordered thresholds and to document the blood glucose value, the notification, and any new orders, and that this was not done for the elevated readings identified in the resident’s record.
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