HospitalInspections.org

Based on policy review, record review, and interview, the facility failed to ensure nursing services provided care as ordered by the physician for 2 of 3 (Patient #1 and #2) sampled patients.

The findings included:

1. Review of the facility policy "Bedside Testing Procedure Accu-check...Point of Care" undated revealed, "...HYPERGYCEMIA PROTOCOL...BLOOD GLUCOSE GREATER THAN 180...Call MD [Medical Doctor] if no order for sliding scale insulin..."

2. Medical record review revealed Patient #1 was admitted to the Emergency Department on 3/7/2022 at 5:25 PM, after recent discharge from hospital for removal of infected Arteriovenous fistula; now complained of extremity pain and fingertips turning dusky. Patient #1 had a history of End-Stage Renal Disease, Peripheral Vascular Disease, and Diabetes Mellitus Type 2.

The Glucose Point of Care (POC) testing dated 3/8/2022 at 4:46 AM, revealed Patient #1 had a result of 291 High (H), with a reference range of 70-110.

The facility did not provide evidence the physician was notifed of the elevated POC reading on 3/8/2022 at 4:46 AM.

The Glucose POC testing dated 3/8/2022 at 4:34 PM, revealed Patient #1 had a result of 457 (H).

The facility did not provide evidence the physician was notifed of the elevated POC reading on 3/8/2022 at 4:34 PM.

Patient #1 was transferred to the floor on 3/8/2022 at 8:07 PM.

The Glucose POC testing dated 3/8/2022 at 10:21 PM, revealed Patient #1 had a result of 478 (H).

The facility did not provide evidence the physician was notifed of the elevated POC reading on 3/8/2022 at 10:21 PM.

In an interview in the conference room on 5/11/2022 at 11:20 AM, Director of Clinical Quality Improvement & Director of Risk Management verified there was no evidence the physician was notified of the hyperglycemia.

3. Medical record review revealed Patient #2 was transferred from the rehabilitation unit to the Intensive Care Unit on 2/28/2022 due to an interventricular hemorrhage. Patient #2 had diagnosis which included Type 1 Diabetes Mellitus (T1DM) and Debility related to Acute Kidney Injury from multiple diuretics for diastolic heart failure. On 3/3/2022, the patient stabilized, his mental status improved back to baseline, and he was transferred to the telemetry unit.

The physicians order dated 3/3/2022 at 9:00 PM revealed, "...insulin glargine...15 unit...subcut [subcutaneously] q [every] Bedtime..."

The Medication Administration record dated 3/3/2022 at 10:00 PM, revealed insulin glargine was not given; insulin coverage not required.

The Nursing Communication dated 3/4/2022 at 9:27 AM revealed, "...once again, do NOT hold any insulins without discussing with me. PT [Patient] has T1DM!..."

The Medication Administration record dated 3/4/2022 at 9:00 PM, revealed insulin glargine was not given; insulin coverage not required.

The physician's progress note dated 3/5/2022 at 11:03 AM revealed, "...Long acting not given because coverage not required per MAR?? Please give all scheduled insulin as scheduled..."

The physicians order dated 3/6/2022 at 9:00 PM revealed, "...insulin glargine...20 unit..subcut...q...Bedtime..."

The physician's progress note dated 3/7/2022 at 6:55 AM revealed, "...MAR reviewed unsure of why nursing staff is withholding patient's...not allowing for tight control of his blood glucose ..."

The Medication Administration record dated 3/7/2022 at 8:14 PM, revealed insulin glargine was not given; insulin coverage not required.

In an interview in the conference room on 5/11/2022 at 11:35 AM, Director of Clinical Quality Improvement & Director of Risk Management verified nurses should administer medications according to the physician orders.