Delay in Hospice Services and Inadequate Pain Management
Penalty
Summary
The facility failed to provide timely and appropriate pain management for a resident with a history of multiple myeloma in remission and poly osteoarthritis, who experienced frequent and significant pain. Despite the resident's request for hospice services due to uncontrolled pain, there was an 8-day delay in arranging hospice care, attributed to the facility's requirement for CEO approval before initiating such services. During this period, the resident continued to report pain levels that were not adequately controlled by the prescribed medications, and her care plan interventions were not fully effective in managing her discomfort. Documentation revealed that the resident's pain was assessed and pain medications were administered, but scheduled doses were missed on at least two occasions without the knowledge of the DON. The facility also failed to consistently document pain monitoring as ordered by the physician, and there was a lack of communication with the physician regarding the resident's breakthrough pain. The resident and her POA both expressed concerns about the delay in hospice services and ongoing pain, while the physician indicated that she expected her orders for hospice and pain management to be carried out promptly due to the critical nature of the situation. Interviews with facility staff and review of facility policy indicated that pain assessments and interventions were not always conducted or documented according to professional standards and the facility's own procedures. The CEO stated that the delay in hospice initiation was due to the need for contract approval, and considered the response time adequate, despite the resident's ongoing pain. The failure to promptly arrange hospice services and to consistently monitor and manage the resident's pain as ordered resulted in a deficiency in providing safe, appropriate pain management consistent with the resident's care plan and preferences.