Failure to Follow Physician Orders for Pain Management
Penalty
Summary
The facility failed to ensure that two residents received appropriate pain management services in accordance with professional standards of practice, facility policy, and physician orders. For one resident with vascular parkinsonism and osteoarthritis, pain medication orders specified different medications for mild, moderate, and severe pain levels. However, medication administration records showed that this resident was given acetaminophen, intended for mild pain, when experiencing moderate pain, and was also administered hydrocodone-acetaminophen, intended for severe pain, during episodes of moderate pain. These discrepancies were confirmed by the nurse supervisor during record review. Another resident with multiple fractures and osteoarthritis had physician orders for acetaminophen for mild pain and varying doses of Norco for moderate and severe pain. Medication administration records indicated that this resident received 1 tablet of Norco, intended for moderate pain, during episodes of severe pain, and 2 tablets of Norco, intended for severe pain, during episodes of moderate pain on multiple occasions. The nurse supervisor confirmed that the pain medication orders were not consistently followed for this resident as well. Interviews with staff, including the Director of Staff Development, Consultant Pharmacist, and Director of Nursing, all confirmed that pain medications should be administered according to physician orders. The facility's policies and procedures also require that pain medications be administered as ordered and in accordance with the resident's care plan. The failure to follow these orders was observed in the medication administration records and confirmed by staff interviews.