Failure to Provide Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide safe and appropriate pain management for two residents by not properly assessing pain, not following physician orders for pain medication parameters, and not documenting or providing non-pharmacological interventions prior to administering PRN pain medications. For one resident, pain assessments were only documented on the day shift, despite orders to assess pain every shift, and pain scores were not consistently recorded. Additionally, the order for oxycodone lacked specific pain parameters after a certain date, and non-pharmacological interventions were not documented as attempted before administering PRN pain medications for several months. For another resident, the MAR showed that PRN oxycodone was administered multiple times without documentation of non-pharmacological interventions being attempted first, as required by the care plan and physician orders. The resident's orders included both Tylenol and oxycodone for different pain levels, but staff administered oxycodone for pain scores that should have been managed with Tylenol, and there was no documentation of Tylenol being given for those pain levels. The DON confirmed that non-pharmacological interventions should be offered and documented prior to PRN pain medication administration and that pain medication parameters should be specified in the orders. Additionally, a scheduled dose of Oxycontin was not administered to a resident because the medication was not available, and the pharmacy had to be contacted for delivery. Staff interviews revealed that medication reordering was based on nursing judgment, and delays could occur due to the need for physician-signed forms for narcotic medications. The DON acknowledged awareness of the missed dose and the issues with pain medication administration and documentation.