Personally I feel that this is a significant error (increased significance owing to the amount of time it has not been done as ordered and has gone unrecognized), although I understand how it happened and how it went unnoticed.
Some things that need to happen (consider them nursing advice based upon my best knowledge/belief, not
When you say you spoke with the doctor's assistant, do you mean a PA? Is the person with whom you spoke a provider responsible for the patient, and is it the person who wrote the original orders, or not? The discovery of error should be reported directly to the person who wrote the order.
How did this person respond when you asked how to proceed?
Secondly, the above conversation with the provider must include a discussion of the patient's best interests/safety going forward - by that I mean now the insulin dose has been increased based on the belief that the patient had already been receiving X amount of medication, which he had in fact not been receiving. So it may not be prudent to increase his dose, but rather to give him a trial of properly receiving the meds as originally ordered. [This being a discussion for you to have, not a decision for you to independently make
According to ethics, the patient (or legal representative, if applicable) should be informed.
You should also follow any policies the facility may have that address occurrences such as this.
You should neutrally document in whatever care record your facility maintains.