Failure to Provide Timely and Effective Pain Management During Hospice Care
Penalty
Summary
A deficiency occurred when a resident receiving hospice care, with diagnoses including encephalopathy, dementia, and failure to thrive, did not receive appropriate pain management during the dying process. The resident had a provider order for morphine to be administered by mouth every two hours as needed for pain, and later, the order was changed to every hour as needed. On the day in question, the resident was noted to be unresponsive, with vital signs indicating distress, including tachycardia, increased respirations, and low oxygen saturation. The medication administration record showed that morphine was given at 9:45 AM and documented as ineffective, but there was no evidence of follow-up interventions or reassessment for several hours. Family members observed the resident to be agitated, air hungry, and sweating, and repeatedly requested additional morphine administration and a change in dosing frequency. Despite these requests and the resident's ongoing symptoms, no further morphine was administered until approximately six hours after the initial dose. During this period, there was a lack of documentation regarding assessment, intervention, or communication with the physician or hospice team about the ineffective pain control. Nursing staff interviews confirmed that standard procedures for ineffective as-needed medication, such as notifying the physician and documenting follow-up, were not followed. Facility policies required staff to assess for pain, monitor effectiveness of interventions, and update care plans as necessary. The failure to administer prescribed morphine in a timely manner, reassess the resident's pain, and communicate with the physician or hospice team as required by policy led to prolonged unmanaged pain and discomfort for the resident during the end-of-life process.