Stonebridge Maryland Heights

Review of resident's electronic Medication Administration Record (eMar) medication administration notes, showed:-On [DATE] at 7:26 A.M., Glucagon injection kit.

Inject 1mg subcutaneously as needed for hypoglycemia.

May give second dose if no response after 15 minutes: Resident's blood sugar is 40 (a blood sugar below 54 is considered severe hypoglycemia, a condition that requires immediate help from another person to treat and can lead to unconsciousness);-On [DATE] at 8:27 A.M., Glucagon injection kit.

Inject 1mg subcutaneously as needed for hypoglycemia.

May give second dose if no response after 15 minutes: Blood sugar was 67, 5 minutes after administration, orange juice given and blood sugar was 127 (normal range), 15 minutes afterward.

Will continue to monitor. PRN (as needed) administration was effective.

Review of resident's progress notes, showed on [DATE] at 3:20 A.M., the Registered Nurse (RN) C found the resident face down on the floor in his/her room, hardly breathing, foaming at the mouth and unresponsive. 911 was called and cardiopulmonary resuscitation (CPR) was started.

When paramedics arrived, they took the resident's blood sugar and administered D10 (dextrose and water mixture given in the vein (IV) to correct hypoglycemia).

Review of the resident's hospital medical record, dated [DATE], showed:-Blood sugar problem: Reading was 27, patient given D5 in route.

Blood sugar was ten 88.

Per EMS, the call was originally for cardiac arrest;-Resident brought in by EMS from skilled nursing facility after episode of unresponsiveness, found down;-Diagnosis: Hypoglycemia.

During an interview on [DATE] at 10:18 A.M., a representative with the emergency medical services company who responded to the 911 call, said when they arrived on scene, the resident's blood sugar was low and they treated it.

During an interview on [DATE] at 11:40 A.M., Licensed Practical Nurse (LPN) A said during his/her shift on [DATE] at around 7:30 A.M., he/she found the resident was not responding at all, so he/she checked the resident's blood sugar level. It was 40. He/She administered glucagon and re-checked it later and it was normal.

The resident was fine the rest of the day, so he/she did not have to check it again after that. He/She made sure the resident got up and had breakfast because he/she knows glucagon only lasts for a little bit and the resident needed to eat so his/her blood sugar did not drop again. LPN A believed he/she had to call the physician to get the order for glucagon, but he/she could not say for sure. He/She believed he/she wrote the change of condition down on the shift change report.

During an interview on [DATE] at 1:35 P.M., Physician Representative E said no one from the facility reached out to Physician B's office on [DATE] for any reason for this resident.

The facility did not notify the physician's staff of the resident's change in condition until [DATE] at 3:51 A.M.

During an interview on [DATE] at 1:50 P.M., the RN C said he/she was not made aware the resident had a prior blood sugar of 40 the morning of [DATE].

During an interview on [DATE] at 2:37 P.M., Family Member D said when Emergency Medical Services (EMS) arrived to the facility, they had to do CPR and resuscitated the resident.

His/Her blood sugar was 27 at that time.

During an interview on [DATE] at 11:04 A.M., Physician B said he/she would have expected the facility to call him in the morning of [DATE] when the resident experienced the low blood sugar level and became unresponsive. If he/she had been made aware he/she would have had the facility hold the Lantus for a day or two, along with holding all the resident's oral diabetes medication on [DATE]. He would have also increased the blood sugar check from once a day to twice a day for the next couple of days.

During an interview on [DATE] at 2:20 P.M., the Director of Nursing said she would expect staff to follow the facility's policies and protocols. 2665394

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