Failure to Ensure Safe and Consistent Pain Management
Penalty
Summary
Facility staff failed to provide safe and appropriate pain management for two residents, as evidenced by inconsistent administration of pain medications and lack of adherence to physician orders. One resident, who had a history of surgical amputation, diabetes, bacteremia, and atrial fibrillation, reported severe pain rated at 10/10 and stated that pain medications were not given regularly and were delayed. Review of clinical records showed that PRN Oxycodone was administered without clear parameters or pain scale, and was sometimes given for a pain score of 0, contrary to the intended use for moderate to severe pain. Additionally, there was no documentation of non-pharmacological interventions being attempted prior to administering PRN pain medications. A second resident, with diagnoses including urinary tract infection, aseptic necrosis of the femur, low back pain, atrial fibrillation, muscle weakness, and legal blindness, also reported chronic, severe pain that was not well managed. Clinical record review revealed that PRN pain medications, including Oxycodone and Acetaminophen, were administered without consistent use of pain scales or parameters, and were sometimes given for pain scores outside the ordered range, including for a pain score of 0. Again, there was no documentation of non-pharmacological interventions prior to medication administration. Interviews with the DON confirmed that PRN pain medications should be administered according to physician orders and that non-pharmacological interventions are expected to be attempted and documented prior to PRN medication use. However, the DON acknowledged that staff did not consistently document these interventions. An LPN also stated that pain medications should be given based on ordered parameters and pain scores, but records showed this was not consistently followed.