Failure to Administer Pain Medication According to Physician Orders and Pain Scale
Penalty
Summary
The facility failed to ensure that pain medications were administered in accordance with professional standards of practice and physician orders for two residents. For one resident with osteoporosis and muscle weakness, the physician's order specified that Oxycodone 5 mg should be administered every eight hours as needed for pain rated 4-6 on the pain scale. However, medication administration records showed that Oxycodone was given multiple times for pain scores less than 4, and there was no nursing documentation explaining the rationale for administering the medication outside the prescribed parameters. The nurse confirmed that the medication was administered outside of the physician's order. For another resident with spinal stenosis and chronic obstructive pulmonary disease, the physician's orders specified Tylenol for pain rated 1-3 and Oxycodone for pain rated 3-6. The resident reported that staff did not ask about pain levels and provided Oxycodone upon request, without offering Tylenol. Medication administration records indicated that Oxycodone was administered outside the ordered pain scale parameters on several occasions, including for pain ratings of 0, 2, 7, 8, and 10, while Tylenol was not administered at all. The nurse acknowledged that the medications were not given according to the physician's orders and that Tylenol should have been administered for lower pain scores. Interviews with nursing staff and the Director of Nursing confirmed that as-needed pain medications are typically tied to specific pain scale ratings and should be administered according to physician orders. The Director of Nursing stated that pain medication should only be given within the prescribed pain scale rating attached to the order. The facility's failure to follow these standards resulted in the administration of pain medications outside of the prescribed parameters for both residents.