Failure to Administer and Properly Prepare Ordered Insulin Doses
Penalty
Summary
The deficiency involves failures in insulin administration for two residents with type 2 DM. For Resident #50, who had multiple comorbidities including type 2 DM with hyperglycemia and no cognitive impairment, the care plan directed staff to administer medications and insulin as ordered. The physician’s order specified Lantus 18 units SQ in the morning. During a morning medication pass, an LPN administered the resident’s eye drops and oral medications but did not give the ordered Lantus dose. In a subsequent interview, the LPN confirmed that the resident did not refuse the injection, there were no parameters to hold the Lantus, she did not contact the provider, and the resident’s blood sugar that morning was 97. The facility’s medication administration policy required staff to contact the prescriber if a dosage was believed to be inappropriate or excessive or if there were concerns about adverse consequences, but the LPN did not do so. For Resident #545, who had type 2 DM and other diagnoses including dementia and chronic kidney disease, the care plan identified a risk for hyper/hypoglycemia and directed staff to administer medications as ordered. The physician’s order specified Lantus SoloStar 10 units SQ in the morning. During observation of a medication pass, an RN prepared the Lantus pen by attaching a needle and dialing the dose to 10 units, then administered the injection in the resident’s lower left abdomen without priming the pen. In an interview, the RN stated she checked the pen for air bubbles and did not know any other way of priming the Lantus pen. The Lantus SoloStar instruction leaflet specifies that a safety test must be performed before each injection, including selecting a 2‑unit dose, removing caps, holding the pen needle-up, tapping to move air bubbles, pressing the injection button, and confirming insulin comes out and the dose window returns to 0. This required priming procedure was not followed prior to administering the insulin.
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