cms_ID: 75
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 75 | GATEWAY TRANSITIONAL CARE CENTER | 135011 | 527 MEMORIAL DRIVE | POCATELLO | ID | 83201 | 2018-04-12 | 655 | D | 1 | 0 | 0IO011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, it was determined the facility failed to ensure a baseline care plan included the instructions needed to provide effective and person-centered care. This was true for 1 of 3 sample residents (#4) whose baseline care plans were reviewed. This deficient practice created the potential for Resident #4 to experience hyper/hypoglycemic (high/low blood sugar) events without the implementation of corrective interventions. Findings include: Resident #4 was admitted to the facility on [DATE] with multiple diagnoses, including diabetes mellitus. Resident #4's 4/2/18 hospital discharge medication list and the resident's (MONTH) (YEAR) facility recapitulation of orders, documented the following medications for diabetes: * insulin [MEDICATION NAME] solution 12 units by subcutaneous injection two times a day; * insulin [MEDICATION NAME] solution per sliding scale before meals and at bedtime, notify the physician if the resident's BG was less than 60 and if the BG was greater than 500, give 12 units of insulin and notify the physician; * [MEDICATION NAME] 1 mg by intramuscular injection as needed for [DIAGNOSES REDACTED] (low blood sugar). Resident #4's care plan documented the potential for nutritional problems related to diabetes. The care plan did not include further reference or interventions related to diabetes. On 4/12/18 at 9:15 AM, the DNS provided the facility's Diabetic Protocol policy and procedure, revised (MONTH) (YEAR), which documented the following: * Call the physician if the diabetic resident has a fever, low blood pressure, lethargy or confusion, abdominal or chest pain, respiratory distress, or functional and/or mental decline. * If the BG is 0-65 and the resident is conscious and able to swallow: give juice, 2% milk or 1 pouch of glucose gel combined with a protein snack, notify the supervisor, recheck the BG in 15 minutes, repeat the intervention and BG check 15 minutes later if the BG is still less than 65 and the resident is alert, notify the physician non-urgently versus STAT (immediately), if the resident becomes unresponsive at any time or becomes extremely lethargic call 911. * If the BG is 0-65 and the resident is unconscious or unable to swallow: give [MEDICATION NAME] 1 mg by subcutaneous or intramuscular injection, notify the physician STAT and notify your supervisor, recheck the BG in 15 minutes, if BG still less than 60 call 911, if BG 65 or over and resident is conscious and talking, offer a protein snack, recheck the BG in 1 hour and resume previous testing orders. * If the blood sugar is over 500: give the maximum units of insulin per the sliding scale orders, notify the physician, recheck the blood sugar in 1 hour, and follow new orders if they are given. * If the blood sugar is over 600: give the maximum units of insulin per the sliding scale orders, notify the physician, recheck the blood sugar in 1 hour, if still Hi notify the physician and do a BMP (basic metabolic profile lab test) STAT, and follow new orders if they are given. On 4/12/18 at 5:40 PM, the ADON said residents who are diabetic should have a care plan for diabetes from the beginning of their stay in the facility. | 2020-09-01 |