Failure to Follow Physician's Orders for Pain Management and Air Mattress Use
Penalty
Summary
The facility failed to meet professional standards of quality by not following physician's orders for pain medication administration and by not ensuring proper documentation and orders for the use of an air mattress for a resident. The resident, who was admitted with diagnoses including cellulitis, acute respiratory failure, and emphysema, was under hospice care and had physician's orders for both scheduled and PRN morphine for pain management, as well as psychotropic medications for anxiety. Despite repeated complaints of severe pain throughout the day, the Medication Administration Record did not show that PRN morphine was administered after the morning dose, even though the resident continued to request pain relief and staff documented ongoing pain complaints. Staff interviews confirmed that no additional PRN pain medication was given prior to the resident's transfer to the hospital for pain management, and the nurse practitioner was unaware that the PRN medication had not been administered as ordered. Additionally, the facility failed to obtain or document a physician's order for the use of an air mattress, including necessary settings and specifications, for the same resident. Nursing notes indicated that the hospice team was contacted to request a new air mattress due to equipment issues, and surveyor observation confirmed the presence of an air mattress in the resident's room. However, there was no evidence in the medical record of a physician's order authorizing the use of the air mattress or specifying its settings, as acknowledged by the Assistant Director of Nursing. These deficiencies were identified through record review, staff interviews, and direct observation, and were substantiated by community complaints submitted to the state health department. The facility's failure to follow physician's orders for pain management and to ensure proper documentation and authorization for medical equipment use resulted in noncompliance with professional standards of quality care.