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Based on record review and interview the requirement was not met in that staff did not consistently administer the correct dose of sliding scale insulin and an antibiotic as ordered.
Review of telephone orders on 08/11/16 revealed orders dated 11/05/15 at 12:09 p.m. were in part as follows:
· Blood Sugar AC and Bedtime
· Bedtime Coverage: yes
· Insulin Subcutaneous: Novolin R - 30 minutes ac
· Scale: low dose

BLOOD SUGARLOW DOSELess than 1200121-1500151-1802181-2104211-2406241-2708271-30010
Review of medication administration records on 08/11/16 revealed the following:
· Medication administration record dated 11/12/15 at 1630 revealed the glucometer reading was 229 and 5 units Novolin R was given instead of 6 units of Novolin R as ordered.
· Medication administration record dated 11/15/15 at 1630 revealed the glucometer reading was
230 and 5 units of Novolin R was given instead of 6 units of Novolin R as ordered.

In an interview on 08/11/16 at 3:55 p.m. in the conference room, the Director of Nursing confirmed the above findings.

Further review of the medication administration records on 08/11/16 revealed the following:
· Medication administration record dated 11/05/15 at 1630 noted " Missed " under an order for glucometer at ac and bedtime. There was no documentation as to why the glucometer reading was not performed. The physician order on that same date, 11/05/15 at 12:09 p.m. for " Blood Sugar AC " was not followed.
· Medication administration record dated 11/05/15 at 1730 noted, " Glu 210 " and there was no documentation that Novolin R was given according to physician orders.

In a telephone interview on 08/24/15 at 9:30 a.m. the Director of Nurses confirmed the above findings.

Further review of a medication administration record dated 11/18/15 at 1800 during a telephone interview of the Director of Nursing on 08/24/16 at 9:30 a.m. revealed Zosyn 3.375 gm IV q 6 hrs had a check mark by it but it did not have a line drawn thru the time and was not initialed as given per hospital policy and there was no documentation in the nurses notes dated 11/18/15 at 9:45 p.m. that the Zosyn was given or that it had been refused.

During the telephone interview on 08/24/16 at 9:30 a.m., the Director of Nursing confirmed the above findings.

Based on record review and interview the requirement was not met in that staff did not consistently administer the correct dose of sliding scale insulin and an antibiotic as ordered.
Review of telephone orders on 08/11/16 revealed orders dated 11/05/15 at 12:09 p.m. were in part as follows:
· Blood Sugar AC and Bedtime
· Bedtime Coverage: yes
· Insulin Subcutaneous: Novolin R - 30 minutes ac
· Scale: low dose

BLOOD SUGARLOW DOSELess than 1200121-1500151-1802181-2104211-2406241-2708271-30010
Review of medication administration records on 08/11/16 revealed the following:
· Medication administration record dated 11/12/15 at 1630 revealed the glucometer reading was 229 and 5 units Novolin R was given instead of 6 units of Novolin R as ordered.
· Medication administration record dated 11/15/15 at 1630 revealed the glucometer reading was
230 and 5 units of Novolin R was given instead of 6 units of Novolin R as ordered.

In an interview on 08/11/16 at 3:55 p.m. in the conference room, the Director of Nursing confirmed the above findings.

Further review of the medication administration records on 08/11/16 revealed the following:
· Medication administration record dated 11/05/15 at 1630 noted " Missed " under an order for glucometer at ac and bedtime. There was no documentation as to why the glucometer reading was not performed. The physician order on that same date, 11/05/15 at 12:09 p.m. for " Blood Sugar AC " was not followed.
· Medication administration record dated 11/05/15 at 1730 noted, " Glu 210 " and there was no documentation that Novolin R was given according to physician orders.

In a telephone interview on 08/24/15 at 9:30 a.m. the Director of Nurses confirmed the above findings.

Further review of a medication administration record dated 11/18/15 at 1800 during a telephone interview of the Director of Nursing on 08/24/16 at 9:30 a.m. revealed Zosyn 3.375 gm IV q 6 hrs had a check mark by it but it did not have a line drawn thru the time and was not initialed as given per hospital policy and there was no documentation in the nurses notes dated 11/18/15 at 9:45 p.m. that the Zosyn was given or that it had been refused.

During the telephone interview on 08/24/16 at 9:30 a.m., the Director of Nursing confirmed the above findings.