Inadequate Pain Management for Resident
Penalty
Summary
The facility failed to provide effective pain management for a resident, identified as Resident 18, who was admitted with diagnoses including fibromyalgia, rheumatoid arthritis, and a complete rotator cuff tear. The facility's policy required an evaluation of pain severity using appropriate scales and the use of non-pharmacological interventions before administering PRN narcotic pain medication. However, the facility did not adhere to this policy. The resident's clinical records showed that PRN Percocet was administered multiple times for pain levels that were documented as mild to moderate, despite the medication being prescribed only for severe pain. Additionally, there was no evidence that non-pharmacological interventions were attempted or documented as ineffective prior to the administration of the medication. Interviews with the Nursing Home Administrator and Director of Nursing confirmed the lack of consistent attempts and documentation of non-pharmacological interventions before administering PRN pain medication. They also acknowledged that the staff administered narcotic pain medication intended for severe pain to the resident when the documented pain levels were only mild to moderate. This indicates a failure to follow the facility's pain management policy and to provide appropriate care as per the resident's needs and physician's orders.
Plan Of Correction
The DON / designee will complete a pain observation for R18. A review for R18's current pain medication and alternative pain management strategies will be completed to determine if the current orders address the current pain severity and that there are alternative pain management strategies in place to offer before resorting to medication. To identify other residents that have the potential to be affected, the DON / designee will complete an audit for current residents taking PRN pain medications to verify if medications are being given as ordered per the pain severity listed and alternative pain management strategies were offered before resorting to medication. Follow up will occur based on the results of the audit. To prevent this from reoccurring, the DON / designee will educate licensed nurses on the Pain Management Policy including administering medications based on severity of the pain and offering/documenting alternative pain management strategies before resorting to medication. To monitor and maintain compliance, the DON / designee will audit 10 residents' records who have received PRN pain medication to ensure that alternative pain management strategies were attempted before resorting to medication and if a medication was administered it was given per the resident's pain severity, as ordered by the physician. The audits will be completed weekly times 4 weeks and then monthly times 3. The results of the audits will be forwarded to QAPI committee for further review and recommendations.