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Based on medical record review, staff interview and review of policy and procedure it was determined the registered nurse failed to ensure nursing assessed, intervened, and evaluated the care of patients for one (#2) of ten patients sampled related to diabetic care.

Findings include:

Patient #2 was admitted on 2/17/2014. Review of the H&P (History & Physical) dated 2/17/2014 revealed the patient had a history of Diabetes Mellitus and was on Insulin at home. Physician orders revealed the Insulin would be continued and the patient's blood glucose was to be monitored before meals and at bedtime.

Review of nursing documentation revealed on 2/19/2014 at 6:12 a.m. the patient's blood glucose was 120 mg/dL. Review of the MAR (Medication Administration Record) revealed the patient received Novolog Mix 70/30, 40 units, at 7:00 a.m. as prescribed. Novolog Mix 70/30 results in insulin activity that is 30% short-acting and 70% long-acting. Review of the record revealed no documentation of the patient's breakfast intake on 2/19/2014.

Review of nursing documentation revealed at 12:41 p.m. the blood glucose was 54 mg/dL. The blood glucose target range for diabetics, according to the American Diabetes Association, should be 90-130 (mg/dL) before meals and less than 180 mg/dL after meals. Review of nursing documentation revealed no nursing note or assessment of the patient at the time of the blood glucose reading of 54 mg/dL noted at 12:41 p.m.

Review of the facility policy, "Hypoglycemia Treatment", #GEN062, last reviewed 11/2013, stated (1) Mild Hypoglycemia: blood glucose 50-69 mg/dL without early symptoms: diaphoretic, shaky, anxious, tachycardia, lip numbness, drowsy, weak, blurred vision (a) call physician STAT if pre-printed insulin order sets not previously ordered. If patient is awake and able to take PO (by mouth), give treatment while notifying physician. Treatment if awake and able to take PO is 15 g (grams) of fast acting carb in liquid form: (one of the following): 4 oz (ounces) juice, 4-6 oz of regular soda, or 8 oz of low fat or skim milk. Then repeat the blood glucose in 15 minutes, repeat treatment if blood glucose remains <70 mg/dL or symptoms persist, and repeat blood glucose every 15 minutes until blood glucose >70 mg/dL and patient is asymptomatic.

Review of the medical record revealed on 2/19/2014 at 12:55 p.m. the physician was notified by the nurse of recent lab results, transfer plans, and an update on the patient. The nurse documented no new orders were received. There was no evidence the nurse administered glucose intravenously or provided fast acting carb in liquid form as stated in facility policy and procedure for hypoglycemia treatment. There was no evidence the nurse communicated to the physician the patient was administered Insulin at 7:00 a.m., did not eat breakfast, and was made NPO (nothing by mouth) at approximately 11:30 a.m. for nuclear medicine testing therefore received no lunch.

Review of the medical record revealed at 12:50 p.m. the patient was transported to the nuclear medicine department for testing. Documentation revealed the patient arrived back to the nursing unit at approximately 2:30 p.m. Nursing documentation revealed the patient was assessed and noted to be unresponsive. The patient's blood glucose was tested and revealed a result of 30 mg/dL. Documentation revealed immediate intervention was provided and the physician notified. Review of the record revealed the patient was transferred to the ICU (Intensive Care Unit).

Review of the record revealed the nurse failed to assess, intervene and evaluate/re-evaluate according to facility policy.

Interview with Quality Coordinator and review of the medical record on 4/8/2014 at approximately 10:00 a.m. confirmed the above findings.