Failure to Provide Timely and Effective Pain Management
Penalty
Summary
The facility failed to ensure effective pain management for three residents who required such services, resulting in periods where pain was not controlled. One resident, admitted with multiple pain-related diagnoses including sepsis, cutaneous abscess, and spondylosis, did not receive prescribed pain medications for the first two days of admission. The resident reported pain at a level of 10 out of 10 and refused tube feedings due to severe discomfort. Medication administration records confirmed that several pain medications, including methadone, baclofen, morphine, and gabapentin, were either unavailable or not administered as ordered during this period. Staff interviews revealed confusion about the medication ordering process and delays in obtaining medications from the pharmacy or electronic dispensing machine. Another resident, admitted with a recent femur fracture and chronic pain, experienced a delay of a day and a half before receiving prescribed pain medication. During this time, the only pain relief provided was over-the-counter acetaminophen, which the resident reported as ineffective for severe pain experienced with movement. Review of records showed that the hospital discharge orders for stronger pain medications were not promptly entered into the facility's system, resulting in a delay in administration. A third resident, admitted for orthopedic aftercare and spinal stenosis, also experienced a delay of several days before receiving prescribed pain medications. The resident reported pain levels of 7-8 out of 10 and stated that only acetaminophen was available initially, which did not provide adequate relief. Medication administration records indicated that several ordered medications, including morphine and pregabalin, were not available or not administered as ordered. Staff interviews and physician statements confirmed issues with medication availability, order transcription errors, and lack of timely communication with providers regarding unavailable medications. The facility's own policy required regular pain assessments and prompt management, but these procedures were not followed, leading to unmanaged pain for the affected residents.