Failure to Promptly Assess and Manage Resident Pain
Penalty
Summary
A deficiency occurred when a resident, who was cognitively intact and enrolled in hospice care, expressed significant pain during personal care. The resident, with a history of pain, dementia, pneumonia, urinary tract infection, and recent falls, repeatedly verbalized pain and requested medication while being assisted by a CNA. Despite the resident's clear and repeated expressions of pain, the CNA continued with care tasks, including transfers and hygiene, without stopping to summon a nurse for assessment or pain management. The facility's pain management policy and standard pain protocol required CNAs to report any signs or symptoms of pain to a nurse immediately, and for nursing staff to assess and manage pain promptly. However, the CNA delayed notifying the nurse, only informing the medication technician after completing care and transferring the resident back to a recliner. The resident's pain assessment and administration of scheduled acetaminophen did not occur until nearly two hours after the initial complaint, and a comprehensive pain assessment by a nurse was not initiated until four hours after the resident first expressed pain. Interviews with facility staff, including the LPN, nurse manager, and DON, confirmed that the expected protocol was not followed. Staff acknowledged that care should have been stopped and a nurse notified immediately for assessment and intervention. The delay in both assessment and administration of pain medication resulted in the resident experiencing prolonged, unaddressed pain, contrary to facility policy and physician orders.