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Based on record review and interview, the facility failed to ensure nursing staff administer medications as required by physician order for 1 of 3 patients (#10).

Findings included:

Review of the medical record for patient #10 on 1/25/2012 at 10:30 a.m. showed an admission on 1/23/2012 for anemia, and a history of diabetes. Review of the physician order/protocol #959-3090A-Adult Basal/Bolus (Multi-Modal) Insulin order dated 1/23/2012 at 7:20 p.m. showed low dose insulin ordered based on blood glucose levels. On 1/25/2012 at 5:53 a.m. the medical record documented patient #10's blood glucose level to be 204. The insulin protocol showed for a blood glucose level of 201-250 the insulin dose would be 3 units of Humalog insulin. The patient's medication administration record showed the patient did not receive any insulin for the elevated glucose level.
During an interview on 1/25/2012 at 10:40 a.m. the assistant registered nurse (RN) manager said the night nurse should have called the physician regarding the blood glucose of 204. The RN also said the patient is NPO (nothing by mouth) and nursing uses their judgment as to whether or not the insulin will be given. The RN confirmed there is no documentation of the night nurse calling patient #10 ' s physician.
During an interview on 1/25/2012 at 10:42 a.m. the RN caring for patient #10 said the night nurse said she would call the physician, but did not know if the physician was called. The RN manager of the nursing unit spoke with patient #10 ' s attending physician and said the physician said he was not contacted regarding the elevated blood glucose.
Review of the policy-Rules for Medication administration, dated as review 11/14/2011, state "The nurse is expected to know the action of each medication and observe the patient for signs of therapeutic results or symptoms of toxicity. The physician is to be informed of any allergic reactions or other related problems the patient manifests. If a scheduled medication is not administered, the clinician must document " not given " plus the reason. An immediate report must be made to the attending if mediation error, Adverse Drug Event or Drug incompatibility has harmed or has the potential to harm the patient. If outcome of medication error is unknown, then physician must be notified. Fill out an incident report and document notification of the physician in the medical record. Clinician is expected to use best clinical judgment on whether to call the physician, based on harm or potential for harm."
Review of the care plan dated 1/24/2012 at 7:26 p.m. showed the patient has a care plan for diabetic management. The care plan states " Monitor blood glucose levels, notify physician if signs and symptoms of hyperglycemia persist or worsen. .. "