Lack of Defined Parameters for PRN Pain Medication Administration
Penalty
Summary
The facility failed to ensure that proper parameters were identified for as needed (PRN) pain medications for one resident. Review of the medical record showed that the resident had multiple diagnoses, including chronic pain, and was prescribed Oxycodone/Acetaminophen with instructions to administer one tablet every six hours as needed for severe pain. However, the order did not define what constituted 'severe' pain. The medication administration record indicated that the resident received the PRN medication daily over a two-week period, with pain levels at the time of administration ranging from zero to nine. A subsequent order for the same medication for moderate pain also lacked a definition for 'moderate' pain. Interviews with nursing staff and the Director of Nursing confirmed that the orders did not specify numeric parameters for 'moderate' or 'severe' pain, and staff relied on their own judgment or the resident's request for medication. The facility's policy required that pain management interventions reflect the severity of pain, but this was not reflected in the physician orders or the medication administration process for this resident.