Failure to Provide Safe and Appropriate Pain Management During Wound Care
Penalty
Summary
A resident with a history of third-degree burns to the right foot, type 2 diabetes mellitus, and recent skin graft surgery was admitted to the facility with specific wound care and pain management orders. The resident's care plan included interventions to provide treatment as ordered, and physician orders were in place for acetaminophen and oxycodone to be administered as needed for pain. Upon admission, the resident's wound care orders from the hospital specified that the xeroform dressing on the donor site (left thigh) should be left in place, washed daily, and not removed until healed. Despite these orders, a wound care nurse attempted to remove the xeroform dressing from the resident's thigh, causing the resident to experience severe pain and bleeding. The nurse did not pre-medicate the resident prior to the dressing removal attempt, and only stopped after the resident expressed extreme pain and refused further care. The nurse later discovered the correct wound care instructions, which indicated the dressing should not have been removed. Documentation and interviews confirm that the resident was not provided adequate pain management before the procedure, and the wound care was not performed according to the physician's orders. The resident reported significant distress, stating that the dressing was removed without proper pain control, resulting in severe pain and bleeding. Staff interviews corroborated that the resident was in extreme pain during the dressing removal and that pain medication was only administered after the incident. The facility's pain management policy emphasizes the importance of addressing pain as reported by the resident, but this was not followed in this instance, leading to unnecessary suffering.