Failure to Provide Appropriate Pain Assessment and Timely Pain Medication
Penalty
Summary
The facility failed to provide safe and appropriate pain management for two residents. For one resident with multiple chronic wounds, advanced dementia, and on hospice care, staff used an inappropriate pain assessment tool. Despite the resident being non-verbal and cognitively impaired, nurses documented pain assessments using a numeric pain scale, which is designed for alert and oriented individuals. The appropriate tool, PAINAD, was only implemented after surveyor intervention, contrary to the facility's policy and the resident's needs. For another resident with a history of lupus, multiple fractures, and chronic pain, the facility failed to ensure the availability of ordered narcotic pain medication. The resident, who relies on scheduled and PRN pain medications, reported severe pain and was unable to participate fully in therapy due to uncontrolled pain. Nursing staff acknowledged that the narcotic medication was not reordered in a timely manner, resulting in a gap of over five hours without the medication. The medication was also unavailable in the facility's pyxis system, and staff were unable to provide an alternative during this period. Both deficiencies were confirmed through observation, interviews, and record review. The facility's own policies required appropriate pain assessment and timely administration of pain medication, but these were not followed. The failures affected two out of four residents reviewed for pain management in a sample of 35.