Inadequate Pain Management for Resident with Chronic Pain
Penalty
Summary
The facility failed to effectively manage and communicate the pain management needs of a resident with severe cognitive impairment and chronic pain conditions. The resident, who had a history of stroke, neuropathy, back pain, and left shoulder pain, was observed experiencing significant pain and cramps in the left leg. Despite the care plan's instructions to evaluate the effectiveness of pain interventions and monitor non-verbal signs of pain, there was inconsistency in documenting the resident's pain location and no medication order for cramps or muscle spasms. The resident frequently complained of left leg cramps, which were not adequately addressed by the nursing staff. During an observation, the resident experienced a painful cramp in the left leg, which was not effectively managed by the CNA, who only provided verbal instructions and repositioning. The RN was unaware of the resident's pain being described as a cramp until the surveyor's intervention. The lack of communication and appropriate treatment for the resident's pain led to the deficiency, as the facility did not ensure the resident's pain was effectively managed according to the care plan and physician's orders.
Plan Of Correction
What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? The physician was notified of the resident's complaint of spasms and an order obtained for relaxant on Resident. The resident was referred to Management practitioner and evaluated on and an as needed order for was obtained. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? An audit of all residents was done to verify they have active orders for assessment. Nursing staff will be reeducated to report all symptoms to primary physicians and Management provider when identified. What measures will be put into place or what systemic changes will you make to ensure that the deficient practice does not recur? Residents will have assessment by licensed nurse every shift to identify incidence of for timely intervention. CNAs will be reeducated to immediately report any complaints by residents of discomfort to the floor nurse and immediately by. How will the corrective action(s) be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into place? A weekly quality review will be conducted by DON or designee weekly x 4, then bi-weekly x 2, then monthly x 1. Quality reviews will be entered by DON in QAPI for monitoring x 3 months or until substantial compliance. Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law.