Failure to Obtain Physician Orders for Hospital Transfer and Glucose Management
Penalty
Summary
The deficiency involves the facility’s failure to obtain appropriate physician orders related to a hospital transfer and to the management of blood glucose levels. One resident (R3), with diagnoses including hypertension, diabetes, and hyperlipidemia, became unresponsive and flaccid during lunch while in a wheelchair. Vital signs at that time showed blood pressure of 88/50, heart rate 75, oxygen saturation 95%, and respirations 26, and the resident required maximum assistance of four staff to return to bed. After returning to bed, the resident became more aroused, with blood pressure 110/58, heart rate 71, respirations 21, and oxygen saturation 94%, and was able to answer questions appropriately. The nurse practitioner directed that the resident be sent to the hospital for evaluation, and the resident’s niece agreed to the transfer; however, review of the physician orders showed there was no physician order documented for the hospital transfer. The ADON confirmed that the facility failed to obtain a physician order for this transfer. A second deficiency was identified for another resident (R2), who had diagnoses including anemia, diabetes, and hypertension. Review of this resident’s physician orders showed an order for Humalog (insulin lispro) 100 units/mL to be administered subcutaneously before meals and at bedtime according to a sliding scale based on capillary blood glucose readings, with specific insulin doses corresponding to blood glucose ranges from 0 to 400 mg/dL. However, the order did not include parameters for when to contact the physician regarding hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) in relation to these capillary blood glucose checks. During interview, the ADON confirmed that the facility failed to obtain physician orders that included management parameters for hypoglycemia and hyperglycemia for this resident.
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