Lack of Pain Management Parameters for PRN Medications
Penalty
Summary
The facility failed to provide pain management services consistent with professional standards of practice for two residents. For one resident, physician orders included as-needed (PRN) medications for pain, such as Acetaminophen and Oxycodone, but the orders did not specify pain level parameters for when each medication should be administered. The resident's medication administration records showed that Oxycodone was given for varying pain levels, including moderate and severe pain, but Acetaminophen was not administered at all during the month. The facility did not have a policy defining mild, moderate, or severe pain, and there was no guidance for nurses on which medication to use based on the resident's reported pain level. For another resident, orders for PRN Acetaminophen and Tramadol were present, but again, there were no pain scale parameters to guide staff on which medication to administer for specific pain levels. The medication administration records indicated that both medications were given for a range of pain scores, including high pain levels, but without documented criteria for their use. Interviews with the DON and Nursing Home Administrator confirmed the absence of pain management parameters and policies, resulting in inconsistent and potentially inappropriate pain management for both residents.