Failure to Provide Timely Pain Management Due to Medication Unavailability
Penalty
Summary
A deficiency occurred when a resident admitted with multiple complex diagnoses, including a left hip fracture, did not receive prescribed pain medication for moderate to severe pain upon admission. The resident had a physician's order for acetaminophen-hydrocodone (Norco) to be administered every four hours as needed for pain, but the medication was not available or administered for two days after admission. During this period, the resident experienced significant pain, with documented pain levels as high as 9 out of 10, both at rest and with movement, as recorded by therapy staff. The resident's pain was severe enough to limit participation in physical and occupational therapy, as noted in therapy encounter notes. Despite the presence of an order for Norco, the medication was not given until two days after admission, and only a one-time dose of Tylenol was administered in the interim. Interviews with staff revealed that the Norco was not available because the pharmacy had not received a signed prescription from the physician, and the emergency kit could not be accessed for Norco without this authorization. Communication lapses were identified, as the pharmacy was not contacted to obtain the necessary script until the resident's pain was reported at a high level. The facility's pain management policy required prompt assessment and treatment of pain, including obtaining necessary medication orders and ensuring availability of prescribed medications. However, the process for securing the Norco prescription was delayed, resulting in the resident experiencing unmanaged pain and decreased comfort and participation in therapy. Staff interviews confirmed that the Norco was not administered until the required prescription was obtained from the physician and processed by the pharmacy.