Failure to Administer PRN Pain Medication According to Physician Orders
Penalty
Summary
The facility failed to ensure that nursing staff administered pain medication according to the parameters specified in the physician's orders for one resident. The resident, who was admitted with a left femur fracture and other diagnoses, was prescribed oxycodone to be given as needed (PRN) based on specific pain ratings: a half tablet for moderate pain (rating 4-6) and a full tablet for severe pain (rating 7-10). Despite these clear parameters, review of the medication administration records (MAR) revealed that licensed nurses administered oxycodone outside of these prescribed guidelines on multiple occasions, including giving the medication when the resident reported no pain or only mild pain. Interviews with the resident indicated that they did not request the oxycodone and expressed concerns about unnecessary use and potential addiction, stating that their pain was manageable by other means. The MAR showed that the medication was given for pain ratings that did not meet the criteria for administration, such as ratings of zero, one, two, three, and four, rather than only for moderate or severe pain as ordered. Nursing staff acknowledged during interviews that the medication should only have been administered according to the resident's reported pain level and the physician's orders, and that the process was not followed. Further review of therapy and rehabilitation notes did not indicate that the resident's participation in therapy was limited by pain, and therapists confirmed that pain did not interfere with therapy sessions. The Director of Nursing also confirmed upon review that the PRN oxycodone had been administered outside of the ordered parameters, which was not in accordance with facility policy or professional standards of nursing practice.