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Based on review of Physician Orders, review of Medication Administration Records and interview, it was determined five (#6, #12, #13, #18 and #20) of eight (#6, #8, #12, #13, #17, #18, #19 and #20) diabetic patients were not administered insulin per physicians' sliding scale insulin orders. Failure to administer insulin per physician order did not assure patients' blood glucose levels were controlled and was likely to affect all diabetic patients admitted to the Facility. Findings follow:

A. Review of Routine Sliding Scale Insulin Orders for Adults for Novolin R (Human Regular) or Novolog (Insulin aspart) revealed the following:
1) Blood Sugar range of 70-150 mg (milligram)/dl (deciliter) - give no insulin;
2) Blood Sugar range of 151-200 mg/dl - give 3 units subcutaneous;
3) Blood Sugar range of 201-250 mg/dl - give 5 units subcutaneous;
4) Blood Sugar range of 251-300 mg/dl - give 7 units subcutaneous;
5) Blood Sugar range of 301-350 mg/dl - give 9 units subcutaneous;
6) Blood Sugar range of 351-400 mg/dl - give 11 units subcutaneous;
7) Blood Sugar range of > (greater than) 400 - call physician; and
8) Blood Sugar range of >450 - draw lab and call physician.

B. Review of Physician Order for Patient #6 revealed he was prescribed Novolog on a sliding scale on 04/30/15. Review of Lab and Medication Administration Records (MAR) for Patient #6 revealed the following:
1) On 04/30/15 at 2051, blood glucose was 189 but no evidence insulin was administered; and
2) On 05/01/15 at 0620, blood glucose was 151 and at 1212 was 153 but no evidence insulin was administered.

C. Review of Physician Order for Patient #12 revealed he was prescribed Novolin R on a sliding scale on 04/28/15. Review of Lab and MAR for Patient #12 revealed the following:
1) On 04/28/15 at 1511 blood glucose was 238 but no evidence insulin was administered;
2) On 04/29/15 at 2135 blood glucose was 159 but no evidence insulin was administered; and
3) On 04/30/15 at 1126 blood glucose was 227 but no evidence insulin was administered.

D. Review of Physician Order for Patient #13 revealed he was prescribed Novolin R on a sliding scale on 04/27/15. Review of Lab and MAR for Patient #13 revealed the following:
1) On 04/27/15 at 1620 blood glucose was 152 and at 2002 blood glucose was 162 but no evidence insulin was administered;
2) On 04/28/15 at 1813 blood glucose was 203 but no evidence insulin was administered;
3) On 04/29/15 at 2046 blood glucose was 186 but no evidence insulin was administered; and
4) On 04/30/15 at 2104 blood glucose was 182 but no evidence insulin was administered.

E. Review of Physician Order for Patient #18 revealed he was prescribed Novolin R on a sliding scale on 01/27/15. Review of Lab and MAR for Patient #18 revealed the following:
1) On 01/27/15 at 0921 blood glucose was 153, at 1437 blood glucose was 178 and at 1761 blood glucose was 170 but no evidence insulin was administered;
2) On 01/28/15 at 0557 blood glucose was 259 but no evidence insulin was administered;
3) On 01/29/15 at 0450 blood glucose was 171 and at 0945 blood glucose was 160 but no evidence insulin was administered;
4) On 02/01/15 at 1626 blood glucose was 277, at 2218 blood glucose was 169 and at 2348 blood glucose was 162 but no evidence insulin was administered; and
5) On 02/02/14 at 0236 blood glucose was 216, at 0450 blood glucose was 223 and at 2108 blood glucose was 169 but no evidence insulin was administered.

F. Review of Physician Order for Patient #20 revealed he was prescribed Novolog on a sliding scale on 01/27/15. Review of Lab and MAR for Patient #20 revealed the following:
1) On 01/27/15 at 2138 blood glucose was 227 but no evidence insulin was administered;
2) On 01/29/15 at 1100 blood glucose was 169 but no evidence insulin was administered;
3) On 02/02/15 at 2036 blood glucose was 182 but no evidence insulin was administered;
4) On 02/03/14 at 2145 blood glucose was 175 but no evidence insulin was administered;
5) On 02/05/15 at 1712 blood glucose was 160 and at 2122 blood glucose was 181 but no evidence insulin was administered;
6) On 02/06/15 at 1645 blood glucose was 161 but no evidence insulin was administered;
7) On 02/07/15 at 1138 blood glucose was 280 and at 1702 blood glucose was 173 but no evidence insulin was administered;
8) On 02/09/14 at 2051 blood glucose was 231 but no evidence insulin was administered;
9) On 02/10/15 at 1457 blood glucose was 193, at 1757 blood glucose was 158 and at 2152 blood glucose was 168 but no evidence insulin was administered; and
10) On 02/12/15 at 2200 blood glucose was 153 but no evidence insulin was administered.

G. Findings listed as B were verified with the Nurse Manager of Cardiac on 05/01/15 at 0930.

H. Findings listed as C-F were verified with the Performance Improvement Coordinator on 05/01/15 at 1020.

Based on review of clinical records and interview, it was determined the Facility failed to assure diabetes was included in the nursing care plan for eight (#6, #8, #12, #13, #17- #20) of eight diabetic patients. Failure to include diabetes in a diabetic patient's care plan did not assure nursing staff were able to assess the patient's progress toward set goals or were able to plan interventions when goals were not met. The failed practice had the potential to affect all diabetic patients in the Facility. Findings follow:
A. Review of the clinical records for diabetic Patients #12, #13, #17-#20 revealed no evidence a care plan for diabetes was included. Findings were verified during record review 05/01/15 at 1020 with the Performance Improvement Coordinator.

B. Review of the clinical records for diabetic Patients #6 and #8 revealed no evidence a care plan for diabetes was included. Findings were verified during record review 05/01/15 at 0930 with the Nurse Manager for Cardiac.