HospitalInspections.org

Based on record review and staff interview it was determined the registered nurse failed to supervise and evaluate nursing care and interventions to meet the needs of a diabetic patient for 1 (#1) of 11 sampled patients.

Findings include:

Patient #1 was admitted to the facility on 11/17/12. Review of the History and Physical dictated on 11/17/12 revealed the patient had a diagnosis of diabetes.

Review of physician orders revealed an order for point of care blood glucose monitoring before meals and at night with sliding scale insulin coverage. The order included a provision that if the blood glucose was over 400, the staff was to repeat the point of care test and if it was greater than 400 the lab was to draw a blood specimen for a glucose test and the physician was to be notified.

Review of nursing documentation of point of care glucose results revealed on 11/18/12 at 11:45 a.m. the glucose was 543. The test was repeated with the result documented as 500. Review of nursing documentation revealed no evidence the physician was notified or the lab was requested to perform a blood glucose test.

The risk management specialist confirmed the finding on 12/4/13 at 11:30 a.m.

Review of blood glucose results for patient #1 from 11/17-11/19/12 revealed the blood glucose ranged from over 200 to a high of 500. Normal blood glucose range is 70-100. The patient was receiving sliding scale insulin based on the readings. The physician ordered the patient's discharge on 11/19/12. Review of discharge instructions revealed there was no instructions regarding management of the elevated blood glucose. There was no documentation the nursing staff consulted the physician regarding post hospital care related to the elevated blood glucose.