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Based on interview and record review the facility failed to ensure a recheck of blood glucose (a laboratory test of the level of sugar in the blood) for one of four sampled patients (Patient 1) after she received intravenous (IV, a small tube in a vein to deliver medication and fluid) insulin (a medication used to treat diabetes, it lowers the level of sugar in the blood).

This failure had the potential to result in a lower than desired blood sugar.

Findings.

Patient 1's record was reviewed. Patient 1 was seen in the Emergency Room (ER) for high blood sugar on 10/8/17 and admitted to the hospital on 10/9/17. Patient 1 had diagnoses that included type one diabetes a condition where the body produces little or no insulin. Insulin is a hormone that helps cells use sugar for energy), and diabetic keto acidosis (DKA, extremely high blood sugar that can lead to unconsciousness and death).

During a concurrent interview and record review with the Director of Nursing (DON) on 12/20/17 at 8 am, she confined that on 10/8/17 at 9:22 am, while in the ER, Patient 1 received 10 units (measurement of volume) of IV insulin. The DON stated that a blood glucose (BG - sugar that is transported through the bloodstream to supply energy to all the cells in our bodies) level should have been rechecked between 30 and 60 minutes, after the IV insulin was administered, to evaluate the effectiveness of the treatment. The DON was asked if there was an physician order to recheck Patient 1's BG after the medication was administered; she replied "No." The DON was asked if there was a protocol allowing a nurse to recheck a BG without a physician order, she replied, "No."

During an interview with Emergency Room Nurse (ERN) on 12/20/17 at 8:13 am, she was asked if there was a policy in place to allow nursing to recheck a blood sugar without a physician order, she replied, "No." ERN stated that when treating high blood sugar with IV insulin the doctor was responsible for ordering a follow up BG between 30 to 60 min after the medication was administered.

During an interview with the medical doctor (MD) on 12/20/17 at 8:50 am he confirmed that that nursing needs an order from the physician to recheck a BG.