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Based on review of the facility's protocol, medical record, and staff interview it was determined the facility failed to ensure a Registered Nurse supervised and evaluated the nursing care related to the care of the diabetic patient for one (#1) of four patients sampled. This practice does not ensure patient goals are achieved.

Findings include:

Patient #1 was admitted on 5/16/10 for hyperglycemia. Nursing documentation dated 6/03/10 at 4:21 a.m. revealed the patient's blood glucose level was 55 (70-110).

Review of the facility's protocol revealed that if the blood glucose level is below 60, repeat the blood glucose and if still below 60, then treat with 15 grams of carbohydrates (4 oz juice). If the patient is NPO (nothing by mouth) or unable to swallow give 50 milliliters of D50 (Dextrose 50%) IV (Intravenous); retest the blood glucose in 15 minutes. If the blood glucose remains below 60, retreat, notify the physician and retest every hour times two.

Review of the patient's diabetes flow sheet revealed nursing gave the patient juice and crackers. There was no documentation the patient's blood glucose was rechecked in 15 minutes.

Interview on 6/28/10 at 1:30 p.m. with the Unit Nurse Manager confirmed there was no documentation nursing rechecked the patient's blood glucose level. Nursing failed to follow the facility's protocol and failed to document the patient's response to the nursing intervention.

2. Patient #1's physician orders dated 6/17/10 at 1:05 a.m. instructed for Lantus Insulin 5 units SQ (subcutaneous) times one now and Novolog Insulin 12 units SQ times one now. Review of the MAR (Medication Administration Record) revealed the patient received Lantus Insulin 5 units SQ and Novolog Insulin 10 units SQ at 1:30 a.m. Interview on 6/28/10 at 2:00 p.m. with the Unit Nurse Manager confirmed the incorrect dose of Novolog was administered.