Pain Medication Administered Outside of Prescribed Parameters
Penalty
Summary
Staff failed to administer pain medication according to the prescribed parameters for a resident with hepatic encephalopathy and alcoholic cirrhosis of the liver with ascites. The physician's order specified Morphine Sulfate 5 mg by mouth every 3 hours as needed for pain levels between 7 and 10. However, documentation on the medication administration record (MAR) showed that the medication was given three times for pain levels of 6, 3, and 6, which were outside the ordered pain scale parameters. Interviews with the registered nurse and the Director of Nursing confirmed that the medication was administered outside of the specified pain scale, contrary to facility policy and prescriber orders. Both staff members acknowledged that PRN pain medication orders require adherence to dosage, frequency, and pain scale, and that the MAR should reflect the pain level and effectiveness of the medication. The facility's policy requires medications to be administered in accordance with prescriber orders, including any required time frame.