Failure to Timely Reorder Pain Medication Resulting in Unavailability
Penalty
Summary
The facility failed to ensure that Hydrocodone, a strong pain medication, was reordered in a timely manner for a resident with spinal stenosis of the lumbosacral region. The resident was admitted with diagnoses that included this condition, which can cause significant pain, numbness, and weakness. On review of the resident's progress notes, it was found that Hydrocodone 5-325 was not administered as prescribed because the medication was not available on a documented date. Interviews with a Licensed Vocational Nurse (LVN) and the Registered Nurse Supervisor (RNS) confirmed that the medication was not reordered when only seven pills remained, as required by facility policy. Both staff members acknowledged that there was no documentation of a timely reorder, and the facility's policy indicated that medications should be ordered in advance. This lapse resulted in the resident not receiving the physician-ordered pain management regimen due to the unavailability of the medication.