Failure to Provide Timely and Adequate Pain Management
Penalty
Summary
A resident with Type II Diabetes Mellitus, Diabetic Polyneuropathy, and muscle weakness was admitted to the facility and had physician orders for Acetaminophen 650 mg every six hours as needed for mild pain, with instructions to notify the physician if more than three doses were given in 48 hours. The resident also had an order for Tramadol 50 mg as needed for pain. Review of the Medication Administration Record showed that the resident received more than three doses of Acetaminophen in 48-hour periods on multiple occasions, but there was no documentation that the physician or advanced practice provider was notified as required. The resident consistently reported high pain levels, rating her pain at eight or higher for most doses administered during this period. On one occasion, the resident experienced unbearable pain and requested stronger pain medication. The DON attempted to contact the nurse practitioner, but did not receive a response, leading the overnight RN to contact the Medical Director, who ordered Tramadol. However, the new prescription could not be sent to the pharmacy immediately, resulting in an 18-hour delay before the resident received the medication. During this time, the resident remained tearful and uncomfortable, and staff attempted non-pharmacological interventions to provide comfort. The delay in medication administration and failure to notify the physician as required by the standing order contributed to inadequate pain management for the resident.