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Based on observation, interview and record review, the facility failed to provide nursing services according to established policies and acceptable standards of practice when Patient 7's tube feeding was stopped but nursing staff did not contact the physician for orders for an alternate source of glucose even though the patient was on long acting insulin, when Patient 8 continued to receive Lantus insulin subcutaneously after an intravenous insulin infusion was started and when no alternate source of glucose was ordered or adjustment of insulin infusion rate was made when Patient 8's total parental nutrition was reduced by 50%. This resulted in Patient 7 developing hypoglycemia (low blood sugar) on 6/27/10 and 6/29/10 and Patient 8 developing hypoglycemia on 6/25/10 and 6/27/10 which required the administration of dextrose 50% intravenously to correct the patients low blood glucose level. Profound and prolonged episodes of hypoglycemia may result in convulsions, unconsciousness, temporary or permanent brain damage, or even death. The facility staff also failed to administer intravenous fluids as ordered by the physician for Patient 9, 10, 11, 12, 13 and 14 in the post anesthesia care unit. The infusion rates were run up to 5 times faster when compared to physicians' orders.

Findings:

1. The facility failed to ensure that insulin was administered in accordance with physicians' orders and established hospital policies. (A-0404).

2. The facility staff failed to administer intravenous fluids as ordered by the physician for patients in the post anesthesia care unit. (A-0404).

The cumulative effects of these systemic problems resulted in the failure of the hospital to provide safe and effective nursing care to its patients.