Failure to Provide Effective Pain Management for Hospice Resident
Penalty
Summary
A resident with a terminal diagnosis and a history of opioid addiction was admitted to hospice care and required comprehensive pain management. Despite having multiple pain medications ordered, including hydromorphone, buprenorphine/naloxone, gabapentin, acetaminophen, and non-pharmacological interventions, the resident's pain was frequently severe and inadequately controlled. Documentation revealed persistent high pain scores, frequent reports of pain, and repeated instances where pain medications were either not administered when indicated or were ineffective. The facility's care plan did not initially address pain management, and there was a lack of consistent pain assessment and follow-up on the effectiveness of interventions. The resident often experienced pain levels of 8 to 10 out of 10, sometimes resulting in the resident calling emergency services and his daughter for help due to unrelieved pain. Nursing progress notes and electronic medication administration records (eMAR) showed inconsistent documentation of pain assessments, medication effectiveness, and communication with hospice regarding the resident's pain. Staff interviews indicated confusion about responsibility for pain management, with some staff believing hospice was solely responsible and failing to report uncontrolled pain to nursing management or hospice. The resident's pain was so severe at times that basic care, such as repositioning and wound assessment, could not be performed without causing significant distress. Observations confirmed the resident was in visible pain, screamed during care, and was not consistently offered additional pain management when needed. The facility also failed to provide a policy regarding pain management when requested. The lack of a coordinated system to monitor, assess, and manage the resident's pain in accordance with professional standards and the hospice plan of care resulted in unnecessary physical and psychological harm. The facility did not ensure that pain was managed effectively, did not update the care plan to reflect the resident's pain needs, and did not communicate effectively with hospice or among staff. The resident's own notes reflected ongoing suffering and a lack of adequate support from facility management.