Failure to Implement Care Plans for Pain Management and Tracheostomy Care
Penalty
Summary
The facility failed to implement care plans for two residents regarding pain management and tracheostomy care. One resident, who was receiving hospice services for end-stage cerebrovascular accident, had a physician's order for morphine sulfate to be administered as needed for pain or dyspnea. Despite exhibiting clear indicators of pain such as yelling out, restlessness, and tenseness, the resident was repeatedly observed calling out for help over several hours without staff intervention. Staff, including nurse aides and an LPN, walked by the resident's room without checking on him, and it was only after a surveyor intervened that the LPN assessed and administered pain medication. The resident's Medication Administration Record showed no documentation of nonpharmacological pain interventions for the month, and there were inconsistencies between the narcotic log and progress notes regarding the dosage of morphine administered. The resident's care plan included multiple interventions for pain management, such as observing for pain, attempting non-pharmacologic interventions, administering medication as ordered, and documenting effectiveness. However, these interventions were not consistently implemented, as evidenced by the lack of nonpharmacological interventions and delayed response to the resident's pain indicators. The Director of Nursing confirmed that the care plan was not being followed in this case. For another resident with a tracheostomy, the care plan required a specific size trach and ambu bag to be kept at the bedside. Upon observation, the required trach size was not present at the bedside, and staff were initially unable to locate the correct size in the facility. It was later determined that the resident had a different size trach in place, and the appropriate spare trach kit was not readily available at the bedside as directed by the care plan. This failure to implement the care plan was confirmed by the Director of Nursing and the respiratory therapist.