Failure to Specify Pain Medication Parameters in Physician Orders
Penalty
Summary
The facility failed to ensure that services provided to residents met professional standards of quality by not including specific pain level parameters in physician orders for PRN pain medications for two residents. For one resident with a fractured wrist, hypertension, and diabetes, the physician's orders for oxycodone and acetaminophen did not specify which medication to administer based on the resident's reported pain level. As a result, the resident received oxycodone for moderate pain levels when acetaminophen could have been administered first, contrary to the facility's analgesia policy that requires nurses to follow pain parameters and document pain scales for pain medications. Another resident, who was severely cognitively impaired and dependent on staff for all activities of daily living, had physician orders for both morphine and oxycodone for pain management. However, these orders also lacked specific pain level parameters to guide the administration of each medication. Medication administration records showed that both medications were given for similar pain levels without clear guidance from the orders. Staff interviews confirmed that nurses relied on their own judgment rather than specific physician instructions, and that pain parameters were not consistently added to pain medication orders.