Failure to Provide Scheduled Pain Medication Due to Medication Availability and Communication Lapses
Penalty
Summary
A deficiency occurred when a resident with multiple complex diagnoses, including multiple sclerosis, palliative care needs, colon cancer, and a cervical vertebra fracture, did not receive pain management in accordance with their comprehensive care plan and physician orders. The resident was prescribed scheduled HYDROmorphone HCl (Dilaudid) and PRN Morphine Sulfate for pain and difficulty breathing. The care plan required administration of medications as ordered and monitoring for effectiveness and side effects. However, there were instances where the scheduled Dilaudid was not available, and the resident missed doses, which led to increased pain and agitation as reported by the resident. Staff interviews revealed that nurses did not consistently reorder pain medications in a timely manner, waiting until supplies were low before notifying hospice or the pharmacy. On one occasion, the resident was not given the scheduled Dilaudid because it was not available, and the nurse did not check the emergency medication box for an alternative supply, despite it being stocked with Dilaudid. Instead, the resident was offered PRN Morphine, which he accepted, but this was not in accordance with the scheduled pain management plan. Documentation errors also occurred, with a nurse mistakenly recording administration of Dilaudid when it was not given. The facility's own policies required assessment and management of pain in all situations where pain was possible, and residents' rights included the provision of safe and appropriate care. Despite these policies, the resident experienced lapses in pain management due to medication availability issues, lack of timely communication with hospice, and failure to utilize available emergency medication stock. These actions and inactions resulted in the resident not receiving pain management as planned and ordered.