Failure to Provide Consistent and Appropriate Pain Management
Penalty
Summary
Facility staff failed to provide safe and appropriate pain management for a resident with a history of chronic pain, liver cancer, and past substance abuse. Staff inconsistently documented the resident's pain levels and did not consistently record the steps taken to address reported pain or whether the pain was relieved. There were multiple instances where staff failed to document timely physician notification when the resident reported significant pain, including pain rated as high as 10 out of 10. Additionally, pain assessments in the medical record and MAR did not always align with progress notes, and there were gaps in documentation regarding pain management interventions. The resident experienced frequent changes in pain medication regimens, including the discontinuation and initiation of various analgesics and opioids. Despite orders for pain medications, staff restricted the resident's access to certain medications, specifically narcotics, without a documented physician order prohibiting their use. When the resident was sent to the emergency department (ED) for pain management, facility staff communicated to the ED that the resident could not receive narcotic pain medications and could not return to the facility if such medications were prescribed, despite the resident's diagnosis of metastatic cancer. This restriction was not supported by a physician order in the resident's record. Interviews with staff revealed a facility-wide approach of prioritizing non-narcotic and non-pharmacological interventions due to the resident's history of substance abuse, even after the resident's diagnosis of terminal cancer. Staff and leadership cited the resident's past substance use as justification for withholding narcotics, but the on-call nurse practitioner stated that effective pain medication should not be withheld regardless of history. The resident reported feeling that pain was not being appropriately managed and expressed a desire to leave the facility due to these issues.