Failure to Timely Order and Administer Pain Medication Due to Lack of Physician Authorization
Penalty
Summary
The facility failed to order and administer pain medication in a timely manner and did not follow up with the physician to obtain the necessary authorization for a narcotic prescription for one resident. The resident, who was admitted with a femur fracture and hypertension, was assessed as having severe cognitive impairment and required moderate assistance with activities of daily living. The care plan for pain management included administering medications as ordered, with specific physician orders for acetaminophen for mild pain and hydrocodone-acetaminophen for severe pain. Despite a documented pain level of 7 out of 10, the resident did not receive any pain medication at the time of assessment. The nurse reported that the pharmacy would not release the narcotic medication because the physician had not signed the required authorization, and the nurse did not escalate the issue to the DON for further follow-up. The resident ultimately received acetaminophen seven hours after the initial pain assessment indicating severe pain. The DON confirmed that the nurse was responsible for ordering and following up on medications and that there was no clear policy specifying when to reorder medications, though the usual practice was to reorder when five pills remained. The facility's policy required a valid prescription for controlled drugs before dispensing, and a chart order alone was insufficient. The lack of timely follow-up and communication with the physician and pharmacy resulted in a delay in pain management for the resident.