Failure to Consistently Manage Pain for Hospice Resident
Penalty
Summary
The facility failed to ensure effective and consistent pain management for a hospice resident, resulting in unnecessary pain and discomfort. Observations and interviews revealed that the resident, who was under hospice care for advanced and progressive disease, received regular doses of ibuprofen and acetaminophen as ordered, but there were concerns from family members and staff regarding delays in administering stronger pain relief, such as morphine. Nursing staff often waited for up to an hour after giving acetaminophen or ibuprofen before considering morphine, even when the resident continued to experience significant pain. Documentation showed that morphine was only administered after repeated requests or when pain persisted despite initial interventions. Review of medication administration records and nursing notes indicated inconsistent documentation of pain assessments and follow-up after pain medication was given. For several months, there was no evidence of regular pain level monitoring, despite a care plan that required pain to be assessed using a 0-10 scale twice daily. When pain was documented, such as shoulder pain rated at 5/10 or 7/10, morphine was not always promptly administered, and family members had to advocate for stronger pain relief. In some instances, morphine was only given after multiple doses of acetaminophen or after direct requests from the resident or family. The facility's hospice plan of care emphasized the goal of relieving or reducing pain and required staff to assess pain characteristics and evaluate responses to medication. However, the records showed that these interventions were not consistently followed, and the resident's pain was not always managed according to the established plan. The lack of timely administration of appropriate pain medication and incomplete documentation of pain assessments contributed to the deficiency in providing adequate comfort and symptom control for the hospice resident.