Failure to Provide Prescribed Pain Management Medications
Penalty
Summary
The facility failed to administer prescribed opioid medications, muscle relaxants, and anticonvulsants for pain control to two residents who required such services. Both residents had documented histories of severe, chronic pain and complex medical conditions, including spinal muscular atrophy, neuralgia, muscular dystrophy, and chronic pain syndrome. Despite physician orders for scheduled pain medications, there were repeated instances where these medications were not available or not administered as prescribed, as evidenced by gaps in the Medication Administration Records (MARs) and Controlled Substances Proof of Use logs. One resident experienced ongoing, uncontrolled, and severe pain, rating it as a 9 out of 10, and reported that the pain became unbearable when pain medications were not available. The resident stated that no alternative interventions were provided, and he simply had to wait until the medication arrived. Another resident, with similar complex pain management needs, described her pain as excruciating and continuous, leading to an emergency room visit for pain relief after not receiving scheduled medications. She reported symptoms of medication withdrawal, a significant decrease in quality of life, and expressed feelings of being forgotten and wanting to die. Interviews with staff, including the DON and LPNs, confirmed that there were ongoing issues with pharmacy transitions, medication ordering, and delivery, resulting in delays and missed doses of critical pain medications. Staff acknowledged that the system required documentation for each medication administration, and blanks in the MAR indicated missed doses. The facility's own policies required timely administration of medications as ordered, but these were not followed, leading to significant unrelieved pain and withdrawal symptoms for the affected residents.
Removal Plan
- Medical Director consulted regarding the availability of pain medication for R1 and R2.
- Medication for R1 and R2 were ordered, received, and administered as prescribed.
- All medication orders received by pharmacy from the physician for R1 and R2 and delivered STAT to the facility.
- An audit for all resident medications for pain was completed by the ADON.
- Medical Director provided pain medication orders to pharmacy.
- Education provided to nursing staff by the Administrator to ensure appropriate identification, documentation, and timely treatment for pain, as well as processes and procedures that assure the accurate acquiring, receiving, dispensing, and administering of medication for pain.
- The Director of Nursing or Designee will provide on-going education to any new or agency nursing staff, not in-serviced, prior to the start of their next shift.
- Pain assessment on the MAR/TAR to be completed by nurse every shift and addressed if pain noted.
- Director of Nursing or designee will conduct audit of pain medication administration to ensure appropriate knowledge and understanding of narcotics delivery, documentation, and administration practices.
- The Director of Nursing or designee will address all concerns identified during the audit.
- The Director of Nursing or designee will report audit findings to the Quality Assurance and Performance Improvement Committee monthly and thereafter as determined by the QAPI Committee.