Failure to Develop Comprehensive Diabetic Management Care Plan and Monitor Hypoglycemia
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive, individualized care plan for diabetic management for one resident with type 2 diabetes and hyperglycemia. The resident’s face sheet and MDS identified a diagnosis of type 2 diabetes, use of hypoglycemic medications, and a therapeutic diet, and the MAR showed an order for a continuous glucose monitoring system (FreeStyle Libre 2) to be applied every 14 days. Although the resident’s diabetes diagnosis was referenced as a related factor in other care plan problem areas (falls, vulnerable adult, nutrition, skin integrity), there was no dedicated diabetic care plan focus. Specifically, the care plan did not identify target blood glucose ranges, use of the continuous glucose monitor, interventions for high or low blood glucose levels, or monitoring and reporting parameters for abnormal readings. It also lacked individualized interventions related to the resident’s hypoglycemic medications and did not address monitoring for signs and symptoms of hyperglycemia or hypoglycemia. Review of blood glucose records, progress notes, and the MAR for a nearly two‑month period showed multiple low blood glucose readings without documented assessment for signs or symptoms of hypoglycemia, without timely rechecks, and without documented interventions to raise blood sugar. Examples included readings of 53 mg/dL, 68 mg/dL, 70 mg/dL, and 59 mg/dL with delays of several hours before rechecks and no documentation of treatment. In interviews, the LPN care coordinator described expected blood glucose ranges, the function of the continuous glucose monitor, and the expectation that staff would check blood glucose more frequently when low and follow protocol, including rechecking within 30–60 minutes after interventions and notifying the provider if levels did not improve. However, the LPN confirmed that the resident’s care plan did not contain specific diabetic management guidance for staff. The DON stated that care plans are updated with significant changes and reviewed quarterly and that care plans should include diabetic management, but the facility’s care planning policy requiring interventions to be derived from a comprehensive assessment and used for daily care was not followed for this resident’s diabetic care.
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