Failure to Administer Insulin in Accordance With Manufacturer Guidelines and Meal Timing
Penalty
Summary
The deficiency involves the facility’s failure to administer insulin in accordance with manufacturer guidelines and good nursing principles for three residents with diabetes. Facility policy required medications to be administered as prescribed and in accordance with good nursing practices. Manufacturer instructions for Humalog (insulin lispro) specified administration within 15 minutes before or immediately after a meal, and for Novolin Regular within 30 minutes before or immediately after a meal. For one resident with diabetes, CHF, and COPD, the record showed a blood sugar of 336 at 5:00 p.m. on 2/26/26, and 10 units of insulin lispro were administered per sliding scale by an LPN. At approximately 5:45 p.m., the resident had not yet received a meal tray and subsequently experienced a hypoglycemic episode requiring administration of Glucagon at 5:50 p.m. and again at 6:10 p.m. Another resident with diabetes, altered mental status, hypertension, and coronary artery disease had an order for Novolin R sliding scale with meals. On 3/05/26, the blood sugar at 11:30 a.m. was 315, and 5 units of Novolin R were administered by an LPN, but the lunch meal was not delivered until 1:25 p.m. That same day, the resident’s evening blood sugar at 4:00 p.m. was 276, and 4 units of Novolin R were given, while dinner was not served until 6:50 p.m. A third resident with diabetes, COPD, gastrointestinal hemorrhage, and hypovolemic shock had an order for insulin lispro sliding scale with meals; on 3/05/26, a blood sugar of 236 at 4:00 p.m. led to administration of 3 units of insulin lispro, while dinner was not served until 6:49 p.m. During interview, the LPN who administered the insulin to the latter two residents stated that insulin was typically given one hour before meals, and the Nursing Home Administrator confirmed insulin should be administered within a short time span before or after meals per manufacturer guidelines.
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