Failure in Person-Centered Pain Management
Penalty
Summary
The facility failed to provide person-centered pain management consistent with professional standards of practice for a resident with chronic venous insufficiency, lymphedema, and Parkinson's disease. The facility's policy required that PRN (as needed) pain medications have defined parameters for use, but this was not adhered to. The resident had physician's orders for tramadol, ibuprofen, and acetaminophen, all as needed for pain, but the orders for tramadol and ibuprofen lacked specific parameters for administration. Despite this, the resident received tramadol for mild or moderate pain on numerous occasions over a three-month period, while no doses of acetaminophen or ibuprofen were administered during this time. The Director of Nursing confirmed that the necessary parameters for the administration of PRN pain medication were not ordered, which is a deviation from the facility's pain management policy. This oversight was identified during a review of the clinical records and an interview with the Director of Nursing, highlighting a failure in the facility's pain management practices for the resident in question.
Plan Of Correction
1. The PRN pain medication orders for Resident 20 were updated to include parameters of usage. 2. Current residents with orders for PRN pain medications have been reviewed to verify defined parameters are ordered. 3. NPE or designee will re-inservice licensed nurses on ensuring that PRN medications have proper defined parameters for administration. Residents with new orders for PRN pain medications will be reviewed during clinical meeting to verify pain parameters are ordered. 4. DON and/or designee will conduct random audits weekly x 8, then monthly x 2 for all residents with PRN pain medications to ensure defined parameters are stated. Audits will be reviewed with the QAPI committee for any further actions or recommendations that may be necessary.