HospitalInspections.org

Based on record review and staff interviews, the facility failed to ensure insulin was administered in accordance with a physician order and facility policy for four of six patients whose medical records were reviewed for insulin administration (Patient #4, #5, #6, and #7). A total of 10 medical records were reviewed.

Findings include:

The policy titled, Insulin Administration - Single & Mixed Dose, revised 08/20/2020, was reviewed. Rapid-acting insulin (like Humalog) "should be administered 10 minutes prior to eating." The policy also directed "have second qualified registered nurse (RN) or licensed practical nurse (LPN) verify dose.

1. Review of Patient #4's medical record revealed a 10/17/2020 order for Humalog per sliding scale TIDAC (three times a day before meals). On 10/18/2020 at 11:02 AM nursing staff recorded a blood glucose (BG) of 254. Per the sliding scale order, Patient #4 should have received eight units of insulin. Nursing staff administered two units at 10:44 AM and an additional eight units at 12:03 PM for a total of ten units.

2. Review of Patient #5's medical record revealed a 10/16/2020 order for Humalog per sliding scale ACHS (before meals and at bedtime). On 10/18/2020 at 6:23 AM nursing staff recorded a BG of 135. Per the sliding scale order, Patient #5 should have received two units. Nursing staff documented no insulin was administered because BG was "below sliding scale."

3. Review of Patient #6's medical record revealed a 10/19/2020 order for Humalog per sliding scale TIDAC. On 10/19/2020 at 12:55 PM nursing staff recorded a BG of 168. No insulin was administered, but per the sliding scale order Patient #6 should have received three units.

4. Review of Patient #7's medical record revealed a 10/16/2020 order for Humalog per sliding scale TIDAC. On 10/18/2020 at 11:50 AM Patient #7's BG was 337, and at 5:20 PM it was 381. Nursing staff administered ten units of insulin to Patient #7 for each instance. Per the sliding scale order, staff was to call the physician when the BG was greater than 300. There was no documented evidence this was done and there was no documented explanation for the administration of ten units of insulin.

On 10/19/2030 at 3:51 PM Patient #7's BG was 315. Again, there was no documented evidence the physician was called.

Staff A was made aware of and confirmed these findings on 10/21/2020 at 9:45 AM. Staff A was asked if the verification by a second RN or LPN involved reviewing the insulin order and BG reading. At 3:22 PM Staff A responded that the facility's plan was to review current "policy and practice related to verification of second nurse."