F0842

D

Failure to Accurately Document Sliding Scale Insulin and Blood Glucose on MARs

Zachary, Louisiana Survey Completed on 03-11-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to accurately document insulin administration and blood glucose monitoring on the Medication Administration Record (MAR) in accordance with its own insulin guidelines and accepted professional standards. The facility’s policy required that when a physician ordered regular insulin on a sliding scale, staff must document the date, time, and results of finger-stick blood sugar testing, the insulin dose given per sliding scale, the injection site, and the nurse administering the insulin. The policy also required charting on the MAR and/or nurses’ notes for these elements.

Resident #3, admitted with diagnoses including obesity due to excess calories, cognitive communication deficit, dysphagia following cerebral infarction, and type 2 diabetes mellitus, had a physician’s order for NovoLog insulin via sliding scale to be given subcutaneously before meals and at bedtime, with blood glucose checks and documentation. Review of this resident’s February 2026 MAR showed no documented evidence that the ordered sliding scale insulin or blood glucose checks were administered or refused on multiple specified dates and times. The March 2026 MAR similarly lacked documentation for an ordered 11:00 a.m. administration and blood glucose check. The LPN assigned to this resident during the relevant shifts confirmed that the MAR entries were blank, acknowledged responsibility for the 11:00 a.m. medications, and stated there should not be any blanks on a MAR, admitting she did not document the administration or refusal of the insulin and blood glucose checks.

Resident #4, admitted with diagnoses including type 2 diabetes mellitus, mild protein-calorie malnutrition, gastrostomy status, long-term insulin use, and cognitive communication deficit, also had a physician’s order for NovoLog insulin via sliding scale with specific instructions for hypoglycemia management and to administer the insulin subcutaneously before meals and at bedtime. Review of this resident’s February 2026 MAR revealed no documentation that the ordered insulin or blood glucose checks were administered or refused at the scheduled afternoon and evening times on a specified date. The March 2026 MAR showed the same lack of documentation for the same scheduled times on another date. The LPN responsible for this resident’s care on those shifts confirmed she was responsible for the 4:45 p.m. and 8:00 p.m. medications, acknowledged the MAR blanks, and admitted she did not document the administration or refusal of the sliding scale insulin and blood glucose checks. The ADON further confirmed that all medication administrations and glucose checks should have been documented and were not.