Marwood Rest Home (December 14th)

Based on interviews with facility staff and review of clinical records it was determined that the nursing home failed to develop plans of care to one resident who refuses accu-checks for two of 17 residents reviewed. Findings included the following: Review of Resident R49’s Medication Administration record noted that there were no nurse’s notes indicating Resident R49’s refusals and no indication that the physician was notified of the refusals. Review of the resident’s current plan of care did not include specific interventions to address the resident’s refusal of accu-checks. Review of nurse’s notes and/or Medication Administration record reported that Resident R63 refused insulin coverage on July 24 and July 25, 2012. There was no indication that the physician was notified of these refusals. Review of the resident’s current plan of care did not include specific interventions to address the resident’s refusal of insulin, accu-checks and insulin coverage. Medication Administration Policy and Procedure #26 states the resident has the right to refuse care and medication if capable and competent. Staff will care plan refusal. An interview with Employee E2 on December 14, 2012 at 11:00 a.m. confirmed these findings.

Based on review of clinical records, facility policy and observation and interviews with staff it was determined that the nursing home failed to ensure that physician ordered protective devices were applied, and that the physician was notified of low blood sugar levels and refusals of medication and blood sugar monitoring for four of 17 residents reviewed. Findings included the following: The review of physician’s orders it was instructed that staff notified the physician if the blood sugar was above 400 and below 70. In review of the facility’s policy and procedure, Insulin Reaction-Hypoglycemic, dated 2012 revealed that when the blood sugar was 50-59 and the resident was alert to offer orange/apple juice or a non-diet soda, milk or graham crackers or glucose gel and recheck the blood sugar. In the case when the blood sugar is less than 50 and the resident was alert, to give juice or milk and a graham cracker or two tubes of glucose. If the resident’s level of consciousness was decreased and the blood sugar was less than 70, give 1 milligram of an undisclosed medication by injection. In all cases, this policy directed that the physician was to be notified. In review of nurse’s notes, dated October 22, 2012, revealed that the resident’s blood sugar was 58 when checked at 6:00 a.m. The note stated that the resident was sleeping and unable to give oral intervention and that undisclosed medication by injection was administered. There was no evidence that the physician was notified of this. On November 12, 2012, nurse’s notes revealed that the blood sugar was 51 at 12:30 a.m. and that the undisclosed medication by injection was administered. No other information was provided as to the resident’s level of consciousness or ability to take oral medication. There was no evidence that the physician was notified.