Failure to Timely Assess and Manage Pain and Blood Glucose
Penalty
Summary
The facility failed to appropriately monitor and comprehensively assess complaints of pain and failed to assess or monitor blood glucose levels for a resident with multiple complex medical conditions, including multiple fractures, trauma, respiratory failure, and diabetes. Upon admission, the resident repeatedly reported severe pain rated as 9/10 on four separate assessments, but was not administered pain medication as ordered and waited approximately nine hours before receiving the prescribed narcotic pain medication. During this period, the resident was only given acetaminophen, which was ineffective, and no further interventions or escalation to the provider were documented. The resident ultimately called 911 due to unrelieved pain and was transported back to the hospital for pain management and assessment. Documentation and interviews revealed that the resident's vital signs were not reassessed after admission until two days later, and blood glucose monitoring was not initiated until two days after admission, despite orders for regular monitoring and the resident's insulin-dependent diabetes. Staff interviews confirmed that blood glucose checks and vital sign assessments were not performed as required by physician orders and facility protocols. The resident expressed concern about the lack of assessment and monitoring, questioning how staff would know if his condition deteriorated. Further investigation found that the facility's emergency medication kit (e-kit) was out of the prescribed pain medication, and the pharmacy did not deliver the medication promptly. The process for obtaining narcotic pain medications was delayed, and staff did not request a stat order or notify the provider in a timely manner. Facility policies required immediate interventions for pain and regular monitoring for diabetic residents, but these were not followed. The director of nursing acknowledged that immediate interventions and assessments should have occurred, and that the resident's blood glucose should have been checked on admission.