Failure to Provide Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide safe and appropriate pain management for four residents, as evidenced by multiple deficiencies in pain identification, medication availability, and assessment practices. One resident with a history of chronic obstructive pulmonary disease, arthritis, and a recent right heel wound reported severe pain for approximately two months, which was not addressed by staff due to a language barrier and lack of pain medication orders. Despite care plan interventions to monitor and manage pain, the resident's complaints were not understood or acted upon, and no pain assessments were conducted by nursing staff. Another resident with a right leg fracture experienced interruptions in pain medication administration due to the facility running out of Oxycodone on multiple occasions. The medication was not available for several scheduled doses, and delays in prescription refills and access to the emergency medication supply were documented. The nurse practitioner and DON were unaware of the medication availability issues until after the fact, and pharmacy communication lapses contributed to the delay in pain management. A third resident with moderate cognitive impairment and a history of neck and shoulder pain was prescribed Tizanidine for neck pain and muscle spasms, but the medication was not clearly indicated for migraine headaches, which the resident also experienced. Staff were unclear about which medication to administer for migraine complaints, leading to confusion and inadequate pain management. Additionally, a fourth resident with multiple fractures and endocarditis did not consistently receive pre- and post-administration pain assessments for PRN Oxycodone, and reported that staff were not always available to provide pain medication as needed. Documentation of pain assessments was lacking, and the resident stated that reassessment of pain after medication administration was rare.