Failure to Complete Physician-Ordered Pain Management Referral
Penalty
Summary
The facility failed to follow a physician's order to refer a resident to a pain management clinic, resulting in a deficiency related to pain management services. The resident, who had a history of traumatic injuries, chronic pain, mental illness, and end-stage COPD, consistently reported significant pain in multiple areas, including the lower abdomen, ribs, shoulder, and hip. Despite ongoing complaints of pain and a documented order for a pain management referral, the referral was not completed. Observations and interviews revealed that the resident was receiving scheduled and PRN medications for pain, including Gabapentin and Methocarbamol, and had previously tried other therapies such as lidocaine patches. Staff interviews confirmed that the resident's pain was being managed with these medications, but the physician's order for a pain management referral, issued several months prior, was not acted upon. The nurse practitioner and LPN were aware of the referral order but were unsure why the resident had not been seen by a pain specialist. Further investigation showed that the responsibility for scheduling the pain management appointment fell to Social Services, but the social worker never received the physician's order and was unaware of the need for the referral. The order was eventually discontinued after 90 days without the appointment being made. The DON acknowledged that the failure to make the referral could delay appropriate care and pain relief for the resident.