cms_ID: 66
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 66 | WEISER CARE OF CASCADIA | 135010 | 331 EAST PARK STREET | WEISER | ID | 83672 | 2016-10-21 | 333 | E | 0 | 1 | 224112 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of the facility's Insulin Quick Reference, and resident and staff interview, it was determined the facility failed to ensure there were no significant medication errors for 4 of 12 sampled residents (#14, #16, #20 and #21) during medication pass observations. The failure created the potential for the residents to experience [DIAGNOSES REDACTED] when rapid acting insulin was administered too early before meals and after Resident #16 said he was not going to eat a meal. In addition, Resident #16's insulin dose was changed without a physician's orders [REDACTED].>The manufacturer documented [MEDICATION NAME] (Insulin [MEDICATION NAME]) as a rapid acting insulin and that an injection of [MEDICATION NAME] should immediately be followed by a meal within 5-10 minutes. On 12/14/16 at 11:10 am, the Administrator provided the facility's Insulin Quick Reference, dated 2002, which documented [MEDICATION NAME] insulin, Should be given just prior to .eating. Regarding [MEDICATION NAME] insulin, the Nursing (YEAR) Drug Handbook patient teaching documented, .give insulin at appropriate time around a meal . 1. Resident #16 was admitted to the facility in 2013 with multiple [DIAGNOSES REDACTED]. Resident #16's Active Orders As Of: 12/14/16 included orders for [MEDICATION NAME]per sliding scale SQ with meals every day, dated 8/3/16. On 12/13/16 at 11:15 am, LN #3 said the lunch meal was scheduled for 12:00 pm and that she usually waits to give sliding scale insulin 30 minutes or less before meals. On 12/13/16 at 11:30 am, Resident #16 told LN #3 that he may not eat lunch. LN #3 told Resident #16 his sliding scale called for 4 units of [MEDICATION NAME]. Resident #16 said he would take 2 units of insulin but not 4 units. Resident #16 also refused 2 oral medications and said he was not going to eat at lunch time. On 12/13/16 at 11:35 pm, the LN was observed as she administered [MEDICATION NAME] 2 units SQ into Resident #16's left abdomen. Resident #16's rapid acting insulin was administered 25 minutes before the lunch meal which he said he was not going to eat and the dose was decreased without a physician's orders [REDACTED].>2. Resident #14 was readmitted to the facility in (MONTH) (YEAR), with multiple diagnoses, including DMII, asthma, and [MEDICAL CONDITION]. Resident #14's Active Orders As Of: 12/14/16 included a 4/6/16 order for [MEDICATION NAME]per sliding scale SQ before meals and at bedtime and a 7/24/16 order for [MEDICATION NAME] suspension inhaled twice a day. On 12/13/16 at 11:10 am, LN #3 was observed as she administered Resident #14's rapid acting [MEDICATION NAME] insulin. At 11:15 am, the LN said lunch was scheduled for 12:00 pm and that she usually waits to give sliding scale insulin 30 minutes or less before meals. Resident #14's rapid acting insulin was administered 50 minutes before the meal. 3. Resident #21 was readmitted to the facility in (MONTH) (YEAR) with multiple diagnoses, including Dm II. Resident #21's Active Orders As Of: 6 included [MEDICATION NAME]per sliding scale SQ before meals, dated 11/22/16. On 12/13/16 at 11:15 am, LN #3 said the lunch meal was scheduled for 12:00 pm and that she usually waits to give sliding scale insulin 30 minutes or less before meals. On 12/13/16 at 11:20 am, LN #3 was observed as she administered Resident #21's rapid acting [MEDICATION NAME] insulin. Resident #21's rapid acting insulin was administered 40 minutes before the meal. On 12/14/16 at 2:40 pm, the DNS said [MEDICATION NAME]should be administered 15 minutes or less before a meal. 4. Resident #20 was admitted to the facility on [DATE], with multiple [DIAGNOSES REDACTED]. Resident #20's (MONTH) (YEAR) physician orders [REDACTED]. The [MEDICATION NAME] dose was to be held if Resident #20 was unable to eat the corresponding meal. The sliding scale was as follows: 0 - 69 = 0 units, refer to hypoglycemic policy 70 - 80 = 0 units 81 - 100 = 3 units 101 - 150 = 12 units 151 - 200 =19 units 201 - 250 = 28 units 251 - 300 = 33 units 301 - 350 = 36 units 351 - 400 = 40 units 401+ - 35 units and notify MD if greater than sliding scale range. On 12/14/16 the following observation were made: *11:10 am, LN #1 checked Resident #20's blood sugar level. It was 234. *11:17 am, LN #1 administered 28 units of [MEDICATION NAME]to Resident #20. *12:05 pm, Resident #20 was in the dining room waiting for his meal to be served. *12:10 pm, the food trays was being delivered to residents in the dining room. *12:20 pm, Resident #20 was being assisted to eat The [MEDICATION NAME] manufacturer documented [MEDICATION NAME] (Insulin [MEDICATION NAME]) as a rapid acting insulin and an injection of [MEDICATION NAME] should immediately be followed by a meal within 5-10 minutes. On 12/14/16 at 2:16 pm, the DNS said, she believed [MEDICATION NAME] should be given 15 minutes before meals. | 2020-09-01 |