Failure to Attempt Non-Pharmacological Pain Interventions Before Administering Opioids
Penalty
Summary
The facility failed to follow its own pain management policy by not attempting non-pharmacological interventions before administering a narcotic pain medication on an as-needed basis to a resident. The policy required that non-pharmacological interventions be tried prior to giving PRN pain medication, and if these interventions failed, medication would be administered according to the resident's pain intensity rating. However, documentation showed that staff did not attempt these interventions or assess the resident's pain level before administering opioid medication. The resident involved had a history of major depressive disorder and unspecified dementia with agitation, and was severely cognitively impaired, as indicated by the absence of a BIMS score on the MDS assessment. The resident had multiple physician orders for pain management, including acetaminophen for mild pain and morphine sulfate for pain or shortness of breath, but the orders for morphine did not specify a pain level or scale, making it unclear when to use each medication as per facility policy. Review of the electronic Medication Administration Record revealed that the resident received PRN morphine sulfate on multiple occasions without any documented attempts at non-pharmacological interventions and without assessment of pain level to determine if a non-opioid medication would have been appropriate. This was confirmed during an interview with the Nursing Home Administrator, who reviewed the findings related to the failure of licensed nursing staff to follow the required pain management procedures.
Plan Of Correction
Resident #19 Morphine order clarified to indicate levels of pain. Cannot go back and retro-correct non-pharmacology interventions for resident #19. To identify like residents that have the potential to be affected, DON/designee audited all residents with PRN pain medication to ensure that residents' pain levels are clarified in the physician order and non-pharmacological interventions are being offered prior to administration of the medication. To prevent this from recurring, licensed staff will be educated on pain management by the DON/designee. To monitor and maintain ongoing compliance, DON/designee to audit 5 residents x4 weeks then monthly x 2 months to ensure that pain levels are completed and non-pharmacological interventions offered prior to administration of the medication. Results to QAPI for recommendations and follow-up.