§ 483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
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Observations:
Based on review of facility policy, clinical record review and staff interview, it was determined that the facility failed to provide treatment and services in a timely manner for a resident with an elevated blood sugar for one of 31 sampled residents. (Resident 57)
Findings include:
Review of the facility policy entitled "Hyperglycemia:Treatment," dated January 1, 2020, revealed that when a resident experienced a hypoglycemic event (low blood sugar) the staff was to monitor the resident vital signs, included remaining with the resident, monitoring blood glucose levels every 15 minutes until stabilzed, and to update the residents family and physican of the residents condition.
Clinical record reviewed revealed that Resident 57 was admitted to the facility on May 22, 2019, with a diagnosis that included metabolic encephalopathy (a chemical imbalance in the brain caused by illness), malnutrition, diabetes and hyperglycemia (high blood sugar). The minimum Data Set assessment, dated August 21, 2019, indicated that the resident's cognition was severly impaired and required extensive staff assistance for activities of daily living. Review of the care plan revealed a problem area related to diabetes with interventions that included for staff to obtain labs and notifying the physican of the results. A progress noted dated October 29, 2019, at 8:15 a.m., revealed that Resident 57 had a blood sugar level of 556 milligrams per deciliter (mg/dl) and that the physican was notified. Documentation at 4:05 p.m., revealed the nurse practitioner was notified by staff to assess the resident. The nurse practitioner had given orders for insulin to be administered. There was no documentation in the clinical record to support that staff stayed with the resident per policy, that vitals signs were obtained, that the blood glucose levels were monitored every 15 minutes until stabilzed and that insulin was administered as ordered by the nurse practitioner.
In an interview on January 8, 2020, at 10:24 a.m., the Director of Nursing confirmed the facility policy, physician orders and care plan interventions, were not followed in response to the residents hyperglycemic episode.
28 Pa. Code 211.12(d)(1)(5) Nursing Services
Previously cited 1/14/19, 2/7/19
28 Pa. Code 211.10 (c) Resident Care Policies
Previously cited 1/4/19
| | Plan of Correction - To be completed: 02/18/2020
The statements made on this plan of correction are not an admission to, and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all federal and state regulations the center has taken or will take actions set forth in the following plan of correction. The following plan of corrections constitutes the centers allegation of compliance.
F684
1. Resident 57 has orders written by the Certified Registered Nurse Practitioner for blood sugars and is currently stable.
2. Diabetic residents getting blood glucose checks will be reviewed for a 2 week look back to ensure that the Medical Doctor/Certified Registered Nurse Practitioner were notified and resident had no ill effects. Residents identified with elevated glucose will have proper Medical Doctor/Certified Registered Nurse Practitioner notification and will be observed per policy.
3. Licensed staff will be educated on F684 and policy regarding hyperglycemia.
4. Director of Nursing/designee will audit 10 random diabetic resident's weekly who are getting blood sugar checks to validate that staff are following the hyperglycemia policy. Results of the audits will be reported to monthly QAPI for 3 months to determine trends or need for further audits.
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