Failure to Develop and Implement Pain Management Plan for Post-Matrixectomy Resident
Penalty
Summary
The facility failed to develop and implement a pain management plan for a resident who was at high risk of experiencing pain due to ingrown toenails and following a matrixectomy procedure on all ten toes. The resident, who had a history of intracerebral hemorrhagic stroke and muscle weakness, was admitted in November 2024 and was previously able to ambulate with a walker. Documentation showed that the resident experienced significant pain, with reported pain levels ranging from 6 to 8 out of 10 on multiple occasions after the matrixectomy. Observations and interviews revealed that the resident experienced ongoing pain when blankets touched his bare nail beds, leading to grimacing, frustration, and feelings of depression. The resident reported that the pain from both the ingrown toenails and the post-surgical condition made it difficult to walk, resulting in a transition from using a walker to a wheelchair. Staff interviews confirmed awareness of the resident's pain and the potential for increased discomfort due to the lack of protective interventions, such as a bed cradle to prevent blankets from contacting the sensitive areas. A review of the resident's care plans indicated that no pain management strategies were documented for either the ingrown toenails or the post-matrixectomy period. The facility's own policy required assessment, recognition, and management of pain, including the use of non-pharmacological interventions when appropriate. Despite this, staff acknowledged that no such interventions were implemented, and the resident's pain was not adequately addressed through individualized care planning.