HospitalInspections.org

Complaint #TX 00194148

Based on record review and interview, the facility failed to ensure insulin ordered by sliding scale was documented as given for 2 of 5 patients (#'s 5 and 10) reviewed who were on sliding scale insulin administration.

Findings include:

Patient #5

Record review of Patient #5's admission sheet revealed she was admitted on 5/2/14 with a diagnosis of diabetes mellitus.

Record review of Patient #5's Medication Administration Record (MAR) dated 5/6 - 5/7/14 revealed a sliding scale for novolog insulin as follows:
From 200 to 250 give 2 units.

There was an order on the MAR to do finger stick blood sugars before meals and at bedtime. On 5/17/14 at 6:00 a.m. the blood sugar level was 221. The patient should have received 2 unit. There was no documentation on the MAR that any insulin was given.

Record review of the patient's Diabetes Record for May 2014 revealed a notation on 5/7/14 at 6:00 a.m. that the blood sugar result was 221. There was a line drawn through the sections that would have noted the drug used, the units, the route and the site of injection.

Record review of the Patient's Nurses' Notes dated 5/7/14 revealed no documentation that any insulin was given at 6:00 a.m.

Interview on 5/7/14 at 11:50 a.m. with RN (Registered Nurse) #65, she said she charted how much insulin she gave on the Diabetic graphic chart. She looked at the Diabetes Record in the patient's chart and agreed there was no documentation that the insulin had been given. She said the 7p to 7a nurse had performed the blood sugar test and the one who would have given the insulin.


Patient #10

Record review of Patient #10's admission sheet revealed she was admitted on 3/31/14 with diagnoses that included diabetes mellitus.

Record review of Patient #10's MAR dated 4/11- 412/14 revealed a sliding scale for novolog insulin as follows:
From 151 - 200 give 2 units
From 201 - 250 give 4 units

There was an order on the MAR to do finger stick blood sugars every 6 hours. A blood sugar test was done at 9:00 p.m. and the result was 175. Two units of novolog should have been given. There was no documentation on the MAR any insulin was given.

Record review of the patient's Diabetes Record for April 2014 revealed a notation on 4/11/14 at 9:00 p.m. that the blood sugar result was 175. There was a line drawn through the sections that would have noted the drug used, the units, the route and the site of injection. Further review of the sheet revealed that on 4/15/14 at 9:00 a.m. the blood sugar result was 192. A line was drawn through the sections that would have noted the drug used, the units, the route and the site of injection. Both sections were signed by different RNs.

Record review of the patient's MAR dated 4/15/14 revealed no documentation that any insulin was given at 9:00 a.m.

Record review of the Patient's Nurses' Notes dated 4/11/14 and 4/15/14 revealed no documentation that any insulin was given at 9:00 p.m. or 9:00 a.m. respectively.

During an interview on 5/7/14 at 2:10 p.m. with House Supervisor RN #57, she looked through the medical records for both Patients #5 and #10 and verified there was no documentation on the MAR, the Diabetes Sheet or in the Nurses' Notes that insulin had been given.

Record review of the facility's Policy and Procedure for Insulin Administration dated 2007 and reviewed on 2/2013 revealed it did not address the use of sliding scale insulin and when and where to document when insulin was given.