Failure to Implement Non-Pharmacological Interventions and Lacking Clear PRN Opioid Parameters
Penalty
Summary
The facility failed to implement non-pharmacological interventions prior to administering a narcotic pain medication and did not ensure that physician orders for the narcotic included clear parameters for use. According to the facility's pain management policy, non-drug interventions such as repositioning, therapy modalities, and relaxation techniques were required before administering PRN pain medications, and pain assessments were to be documented using a numerical scale or the PAINAD tool. For one resident with severe cognitive impairment, diabetes, neuropathy, and peripheral vascular disease, the clinical record showed that Tylenol was administered on several occasions with documentation of attempted non-pharmacological interventions, but without recording pain scale ratings or clinical rationale for medication selection. On a specific occasion, the resident received Oxycodone for a pain rating of 9 out of 10, but there was no documentation that non-pharmacological interventions were attempted prior to administration, as required by both facility policy and physician orders. Additionally, the physician's order for Oxycodone lacked defined parameters, such as pain scale thresholds, to guide staff in determining when to administer the opioid. The Nursing Home Administrator confirmed these findings during an interview, acknowledging the absence of required documentation and specific criteria in the physician's order.