Failure to Provide Timely Pain Management and Medication Availability
Penalty
Summary
The facility failed to ensure the timely availability and administration of both scheduled and as-needed pain medications for a resident admitted with a tri-malleolar fracture and a history of malignant carcinoid tumors and adjustment disorder with depressed mood. Upon admission, the resident was prescribed hydrocodone-acetaminophen (Norco) as needed for moderate pain and pregabalin for nerve pain. Documentation showed that the resident experienced frequent, moderate to severe pain, with pain scores of 8-9 out of 10, and reported inadequate pain relief after receiving the as-needed medication. The Medication Administration Record indicated that pregabalin was not documented as given at bedtime on the day of admission, and only administered during the morning medication pass the following day. Nursing progress notes revealed that the resident expressed significant distress due to pain and the lack of timely medication, even considering leaving the facility against medical advice. Staff interviews confirmed delays in obtaining and administering the prescribed medications, with pharmacy deliveries not arriving as scheduled and the e-kit being accessed only after the resident's complaints. The facility's policy required that services needed by residents be readily available, and that prescriptions be obtained within a few hours of admission, but these expectations were not met in this case.