Failure to Administer Pain Medication According to Physician Orders
Penalty
Summary
A deficiency occurred when a nurse administered hydrocodone-acetaminophen, a controlled medication prescribed for severe pain (pain level 8-10), to a resident experiencing moderate pain (pain level 6) and on multiple occasions for pain levels below the prescribed threshold. The physician's order specifically stated that hydrocodone-acetaminophen 5-325 mg should be given every 12 hours as needed only for severe pain, and not to exceed 3 grams of acetaminophen in 24 hours. Despite this, the medication was given for pain levels ranging from 4 to 7, which did not meet the criteria for severe pain as outlined in the order. The resident involved had a history of chronic pain conditions, including generalized arthritis, low back pain, migraine, and chronic pain syndrome. The resident was cognitively intact and required assistance with activities of daily living. During medication administration, the nurse acknowledged that the resident's pain level was 6 but proceeded to administer hydrocodone-acetaminophen, citing the resident's need for therapy as a reason. Review of the Medication Administration Record (MAR) over several months revealed at least 15 instances where the medication was administered outside of the prescribed pain parameters. Interviews with nursing staff and the Director of Nursing confirmed that the medication was not given in accordance with physician orders or professional standards of practice. The facility's policy required medications to be administered as prescribed and for staff to consult the prescriber if there were concerns about dosage or appropriateness. The nurse involved recognized the importance of following pain level parameters and admitted that the order should have been clarified with the physician if the resident's pain management needs had changed.