Inconsistent Timing of Long-Acting Insulin Administration
Penalty
Summary
The deficiency involves the facility’s failure to administer long-acting insulin at consistent times in accordance with manufacturer instructions for two residents prescribed Lantus (a long-acting insulin). One resident had type 2 diabetes with diabetic polyneuropathy and long-term insulin use, with a care plan directing diabetes medications to be administered as ordered. The physician ordered Basaglar 62 units twice daily, which was transcribed on the March 2026 medication administration record (MAR) as Lantus 62 units twice daily with administration windows of 7:00 a.m.–11:00 a.m. and 7:00 p.m. (HS). The manufacturer’s package insert for Lantus states it may be taken at any time of day but must be taken at the same time every day. MAR review showed the evening doses were given at varying times, including examples such as 9:41 a.m. and 10:32 p.m., 9:17 a.m. and 9:43 p.m., 8:29 a.m. and 10:42 p.m., and 9:04 a.m. and 8:27 p.m., rather than at a consistent time. Another resident with type 2 diabetes, on a therapeutic diet and receiving insulin injections seven days per week, had a physician order for Lantus 20 units daily. The March 2026 MAR listed Lantus 20 units in the morning with an administration window of 7:00 a.m.–11:00 a.m., but actual administration times varied, including 8:27 a.m., 10:00 a.m., 8:52 a.m., 12:09 p.m., and 7:58 a.m. Staff interviews confirmed that long-acting insulin should be given at the same time every day for effectiveness, and that nurses transcribed orders using time windows when specific times were not provided. The RN nurse manager acknowledged that Lantus might be one medication where a specific time is preferred, and the DON stated that long-acting insulin orders are not always written with specific times unless the provider specifies one. The consulting pharmacist stated that long-acting insulin should be given with a very small window and that giving doses at different times daily could result in hyperglycemia or hypoglycemia and potentially ketoacidosis. The facility’s insulin administration policy described long-acting insulin characteristics but did not prevent the inconsistent timing documented on the MARs.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.