Failure to Provide Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide safe and appropriate pain management for two residents, resulting in deficiencies related to the administration and monitoring of pain interventions. One resident, who was receiving hospice care for end-stage illness following a cerebrovascular accident, had physician orders for morphine sulfate to be administered every two hours as needed for pain or dyspnea, along with nonpharmacological interventions. Despite exhibiting clear indicators of pain such as yelling out, restlessness, and tenseness, the resident was left unattended and unassessed for approximately 50 minutes while audibly calling for help. Staff, including nurse aides and an LPN, did not enter the room to assess the resident until prompted by a surveyor. Upon assessment, the resident confirmed pain and was administered medication, which led to a reduction in distress. Review of records revealed that nonpharmacological interventions were not documented or implemented, and the resident did not receive the correct dose of morphine on multiple occasions, with discrepancies noted between the medication administration record and the narcotic log. Additionally, the resident's care plan included specific interventions for pain management, such as observing for pain, attempting nonpharmacological interventions, administering medication as ordered, and documenting effectiveness. These interventions were not followed, as evidenced by the lack of documentation and implementation of nonpharmacological approaches and the failure to administer the correct medication dose. The DON confirmed that the care plan was not being implemented as required, and the resident's pain management needs were not met according to physician orders and care plan directives. A second resident with an order for hydrocodone every six hours for pain also experienced deficiencies in pain management. Review of the medication administration record and controlled substance log showed that on two occasions, the medication was documented as administered but was not signed out on the controlled substance log, indicating it was likely not given. This was confirmed by a corporate RN, further demonstrating a failure to ensure that pain medications were administered as ordered and properly documented.