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Based on review of clinical records and interview, it was determined 3 (#7-9) of 10 (#1-10) clinical records had no evidence of an Important Message from Medicare. Failure to assure Medicare patients were provided the Important Message from Medicare did not assure the patient was made aware of or understood their rights to receive care or that care could be discontinued. The failed practice was likely to affect all Medicare patients admitted to the Facility. Findings follow:

Review of the clinical records for Medicare Patients #7, #8 and #9 revealed no evidence of an Important Message from Medicare. Findings were confirmed with the Regulatory Officer on 04/21/15 at 1330.

Based on clinical record review and interview, it was determined two (#8 and #9) of three (#7-#9) insulin dependent patients did not receive insulin per physician's orders. Failure to administer insulin per physician's orders had the potential for inadequate blood sugar control as well as prolonged hospitalization. The failed practice affected two (#8 and 9) of three (#7-#9) patients on 04/20/15. Findings follow:

A. Review of Patient #8's clinical record revealed the Glucose Management Protocol as treatment for diabetes mellitus. The Glucose Management Protocol stated not to give bedtime insulin and notify MD (Medical Doctor) if BS> (blood sugar greater than) 250. Review of the clinical record revealed a blood sugar of 258 at HS (hour of sleep) at 2048 on 01/08/15 and no documentation the doctor was notified. Review of the clinical record also revealed on 01/10/15 the morning blood sugar was 303 which required 9 units of insulin per the protocol. Review of the MAR (medication administration record) revealed Patient #8 received 8 units of insulin. Review of the clinical record revealed three different HS blood sugar readings on 01/10/15. Review of the MAR revealed Patient #8 was given 11 units of insulin and the doctor was not notified of the blood sugar. During an interview with RN (Registered Nurse) Analyst #1 at 1135 on 04/20/15 she verified the findings.

B. Review of Patient #9's clinical record revealed the Glucose Management Protocol as treatment for diabetes mellitus. The Glucose Management Protocol stated not to give bedtime insulin and notify MD (Medical Doctor) if BS> (blood sugar greater than) 250. Review of the clinical record revealed a morning blood sugar of 171 on 01/15/15 and no documentation Patient #9 received the one unit of insulin per the Glucose Management Protocol. Review of the clinical record revealed a morning blood sugar of 231 on 01/16/15 and no documentation Patient #9 received two units of insulin per the Glucose Management Protocol. Review of the clinical record revealed a HS blood sugar reading of 289 on 01/18/15. Review of the MAR revealed Patient #9 was given 3 units of insulin and the doctor was not notified of the blood sugar. During an interview with RN Analyst #2 at 0950 on 04/20/15 she verified the findings. Review of the clinical record revealed three different HS blood sugar readings on 01/10/15. Review of the MAR revealed Patient #8 was given 11 units of insulin and the doctor was not notified of the blood sugar.