cms_TN: 27
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 27 | ASBURY PLACE AT MARYVILLE | 445017 | 2648 SEVIERVILLE RD | MARYVILLE | TN | 37804 | 2017-07-27 | 514 | E | 1 | 0 | 4611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of the facility policy, review of Brunner and Suddarth's Textbook of Medical Surgical Nursing, medical record review, and interview, the facility failed to provide sufficient documentation to determine the status or progress after the implementation of care for 4 diabetic residents (#5, #6, #16, and #18) of 17 residents reviewed for insulin, of 24 residents reviewed. The findings included: Review of the Facility Policy Medication Administration and Med Pass Schedule, revised (MONTH) (YEAR), revealed, .when PRN (as needed) medications are administered, the nurse must record .date and time administered .dosage . Review of the facility's Insulin Administration Policy revised (MONTH) 2010 revealed, .Procedure .check blood glucose per physician order .Documentation .resident's blood glucose results, as ordered . Review of Brunner and Suddarth's Textbook of Medical Surgical Nursing Twelfth Edition, chapter 41 revealed, .Because the insulin dose required by the individual patient is determined by the level of blood glucose in the blood, accurate monitoring of blood glucose levels is essential . Medical record review revealed Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of Resident #5's Care Plan Dated 8/11/17 revealed, .Potential for increased or decreased blood sugar levels .[DIAGNOSES REDACTED] (low blood sugar) .Goals .blood sugar (greater than) 70 or (less than) 110 (every) day .accuchecks (lab to monitor blood sugar levels) as ordered .insulin as ordered .see MAR (Medication Administration Record) . Medical record review of Physician Orders dated 3/21/17 revealed, .(increase) chemsticks (blood sugar testing) to AC/HS (before meals and bedtime) . Medical record review of Physician Orders dated 3/27/17 revealed, .Humalog (insulin) 6 (units) with lunch and supper .hold if (blood glucose) (less than) 150 . Medical record review of Resident #5's MAR dated (MONTH) (YEAR) revealed 27 administrations of insulin, without documentation of the resident's blood sugar, out of 60 opportunities. Medical record review of Resident #5's MAR dated (MONTH) (YEAR) revealed 26 administrations of insulin, without documentation of the resident's blood sugar, out of 62 opportunities. Medical record review of Resident #5's MAR dated (MONTH) (YEAR) revealed 28 administrations of insulin, without documentation of the resident's blood sugar, out of 54 opportunities. Medical record review of Resident #5's MAR dated (MONTH) (YEAR) revealed, 24 administrations of insulin without documentation of the resident's blood sugar, out of 41 opportunities. Medical record review revealed Resident #16 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of Physician's Order on Resident #16's MAR dated 5/15/17 revealed, .[MEDICATION NAME] (insulin) .(6 units) .two times daily .Hold if (blood sugar) (less than) 120 . Medical record review of Resident #16's MAR dated (MONTH) (YEAR) revealed 25 administrations of insulin, without documentation of the resident's blood sugar, out of 27 opportunities. Medical record review of Resident #16's MAR dated (MONTH) (YEAR) revealed 34 administrations of insulin, without documentation of the resident's blood sugar, out of 37 opportunities. Interview with Licensed Practical Nurse (LPN) #8, Nurse Manager, on 7/25/17 at 3:58 PM, in the Director of Nursing (DON) office, confirmed there was incomplete documentation in the medical record. Medical record review revealed Resident #18 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Medical record review of the Consultant Pharmacist's Medication Regimen Review for Resident #18 dated 4/1/17-4/11/17 revealed, .there is no space for recording (blood sugar) on EMAR (Electronic Medication Administration Record) with the order so unclear if this has been done consistently . Medical record review of Resident #18's MAR dated 4/20/17 revealed, .Humalog (8 units) .Notes .hold if below 110 If greater than 400 give 4 additional units . Medical record review of Resident #18's MAR dated (MONTH) (YEAR) revealed blood sugars over 400 on 5/2 at 4:46 PM, 5/6 at 1:10 PM, 5/6 at 5:06 PM, 5/7 at 7:39 AM, 5/7 at 4:34 PM, 5/8 at 4:40 PM, 5/23 at 9:48 AM, 5/30 at 7:52 AM, and at 5/30 at 11:30 AM. Further review revealed no documentation if the additional 4 units of insulin were administered per physician order. Interview with LPN #8, Nurse Manager, on 7/26/17 at 11:10 AM, in the DON's office, confirmed if there was not a physical monitor (a space on the MAR for nurse to document the number of insulin units) placed on the MAR with the insulin order, then there was no place to document the amount of insulin given. Medical record review revealed Resident #6 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Medical record review of the MAR dated (MONTH) (YEAR) revealed .[MEDICATION NAME] R (insulin) .Three Times Daily Starting 6/28/2017 .Blood Sugar is 151.00-200.00 (give) 4 units .Blood Sugar is 251.00- 300.00 (give) 6 units . Continued review revealed no sliding scale for blood sugar results of 201-250 on the MAR. Further review revealed on 6/30/17 the blood sugar was 214 and 6 units of insulin was given. Medical record review of the MAR dated (MONTH) (YEAR) revealed the following: 7/2/17 at 9:00 PM-blood sugar 215-4 units of insulin given 7/5/17 at 9:00 PM-blood sugar 215-4 units of insulin given 7/4/17 at 9:00 AM-blood sugar 152-2 units of insulin given Interview with LPN #10 on 7/20/17 at 4:05 PM, by phone, confirmed she was not aware there was an incomplete scale order on Resident #6's MAR. Interview with LPN #7 on 7/20/17 at 5:20 PM, by phone, confirmed she entered the insulin order in the computer for Resident #6 on 6/28/17. Further interview confirmed she entered the order manually instead of picking an order set from the library and made an error during the order entry. Interview with the Administrator on 7/19/17 at 11:00 AM, in the DON's office, confirmed a 24 hour chart check was completed nightly by the night shift nurse to ensure orders and documentation was correct. Interview with the DON on 7/26/17 at 2:35 PM, in the DON's office, confirmed nurses were not entering insulin orders correctly. Further interview confirmed insulin orders were not to be put in manually unless it was a scale other than scale A or B. Continued interview confirmed transcription errors should be identified during the 24 hour chart checks. Interview with the Administrator on 7/26/17 at 6:42 PM, in the DON office, confirmed documentation was .not as good as it should be . Interview with the Administrator on 7/27/17 at 7:45 AM, in the DON office, confirmed blood sugars should be documented on the MAR. Continued interview confirmed if no blood sugars were documented, .how are we supposed to know . if the correct dose had been given. Refer to F333 | 2020-09-01 |