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Based on physician order review, medical record review, and staff interviews, the nursing staff failed to demonstrate the percentage of meals taken by a patient related to the insulin dose administered following a physician's medication order in 1 of 2 patients reviewed. (Patient #1)

Findings revealed:

Review on 09/21/2023 of the Physician Order, dated 08/11/2023 at 1230 by Medical Doctor (MD) #1 revealed "insulin (naturally occurring hormone made by your pancreas that helps your body use sugar for energy) Lispro (brand) (Humalog) [rapid acting medication to manage blood sugar] injection 5 units, subcutaneous (applied under the skin), frequency: 3 times daily with meals...First dose scheduled 08/11/2023 at 1300...Admin (administration) instructions: If being used for mealtime coverage: HOLD when patient NPO (nothing by mouth) or Patient eats LESS THAN 25% of meal. If a patient eats 25 to 50% of the meal: GIVE 50% if dose. When patient eats more than 50 % of meal: Give 100% of dose..."

Closed medical record review on 09/21/2023 revealed Patient #1, an 80-year-old female who presented to hospital on 08/10/2023 with acute respiratory symptoms, was diagnosed with COVID-19 (a respiratory virus) and admitted to room 347 on 08/11/2023 at 1716. Patient #1 had a past medical history of Diabetes Type II (the body is unable to produce or use insulin correctly) and was ordered a Mediterranean 2-gram Sodium diet (meals with fruits, veggies, fish, beans, whole grains, and heart-healthy fats) on admission. The Physician Order on 08/11/2023 at 1230 by MD #1 revealed Patient #1 was to be administered insulin three times a day with meals, based on the percentage of meals consumed by Patient #1 starting on 08/11/2023 at 1300. Review of the medical record for 08/12/2023 revealed no meal percentages were demonstrated in correlation to the insulin administered by nursing staff for Patient #1 breakfast, lunch, or dinner. Review of the Medication Administration Record (MAR) dated 08/12/2023 revealed Humalog injection 5 units was administered by Registered Nurse (RN) #2 at 0850, 1210, and 1725. Review of the medical record for 08/13/2023 revealed no meal percentages were demonstrated in correlation to the insulin administered by nursing staff for Patient #1 breakfast, lunch, or dinner. Review of the MAR for 08/13/2023 revealed Humalog injection 5 units was administered by RN #2 at 0950 and at 1724. Review of the medical record on 08/14/2023 revealed no meal percentages demonstrated in correlation with the insulin administered for Patient #1 breakfast and lunch by the RN #2. Review of the MAR on 08/14/2023 revealed Humalog 5 units was administered by RN #2 at 0832, and at 1233. Record review revealed 8 meals where RN #2 failed to demonstrate the percentage of meals taken by Patient #1 to justify the Humalog insulin dose administered following the physician orders. Patient #1 was discharged back to the skilled nursing facility on 08/14/2023 at 1626.

Request on 09/21/2023 to interview RN #2 revealed she was unavailable for interview.

Interview on 09/21/2023 at 1350 with the Nursing Director for the Medical Units, RN #3 revealed the expectation was for RN #2 to demonstrate meal percentage taken by Patient #1 related to the insulin dose that was administered following the physician's order. The interview revealed the percentage of meals taken by Patient #1 should be documented in the record. The interview revealed RN #2 did not meet the expectation for documenting the meals consumption for Patient #1.

Interview on 09/21/2023 at 1611 with the Assistant Clinical Supervisor on the Medical floor, RN #4 revealed the percentage taken by a patient should be completed every meal by the nurse or nurse technician. "...The nurse often times will add the percentage in the MAR to justify the dose of insulin administered..." The interview revealed RN #2 did not meet the expectation for documenting the meals consumption for Patient #1.

NC00202696, NC00205097