Failure to Provide Adequate Pain Management for Resident with Orthopedic Implants
Penalty
Summary
A resident with a history of internal orthopedic prosthetic devices and a right artificial hip joint experienced unrelieved pain due to the facility's failure to provide adequate pain management. The resident was admitted with diagnoses requiring ongoing pain control and had physician orders for acetaminophen and oxycodone to be administered as needed based on pain severity. The care plan included interventions for pain assessment, medication administration, and monitoring, with the goal of achieving satisfactory pain control. Despite these orders and interventions, the resident consistently reported severe pain, frequently rating it as 9 out of 10, and exhibited signs of distress such as moaning, facial grimacing, and difficulty participating in mobility exercises. Staff interviews revealed that the resident's pain was not effectively managed, with pain medication often not administered at the maximum frequency allowed by the physician's orders. Additionally, staff failed to communicate the resident's ongoing pain and lack of relief to the physician or the interdisciplinary team, and no pain management consultation was initiated. Observations and interviews confirmed that the resident's pain interfered with daily activities and mobility, and staff acknowledged that the pain was not well controlled. The Director of Nursing and the resident's physician both confirmed that the resident's pain status was not reported as required, resulting in the resident experiencing ongoing, unrelieved pain. The facility's own pain management policy required staff to evaluate and report pain that was not responding to interventions, which was not followed in this case.