Failure to Provide Timely Pain Management for Resident with Contracture and Post-Fall Pain
Penalty
Summary
A resident with a history of stroke, right-sided weakness, aphasia, vascular dementia, contracture of the right elbow, anxiety, and depression was admitted to the facility and identified as being at risk for musculoskeletal complications, including pain. Despite a care plan that included monitoring and reporting signs of pain, the resident was not provided with any scheduled or as-needed pain medication, nor were non-pharmacological interventions implemented. Multiple clinical notes from occupational therapy and nursing staff documented the resident exhibiting clear signs and symptoms of pain, such as groaning, grimacing, pulling away during care, and refusing therapy and activities of daily living (ADLs), particularly after a fall. The resident's pain was further evidenced by increased resistance to care and changes in arm positioning following the fall. Interviews with staff, including nurse aides, the occupational therapist assistant, and the nurse practitioner, revealed that the resident's pain behaviors were observed during care and therapy sessions. However, nurse aides did not consistently report these observations to nursing staff, often assuming the pain was related to the resident's contracture and that nurses were already aware. Nursing staff did not assess or document the resident's pain, nor did they notify the physician or nurse practitioner in a timely manner. The nurse practitioner acknowledged that pain management should have been initiated sooner, as the resident's pain was only addressed after repeated reports and a significant delay following the fall. Physician and director of nursing interviews confirmed that there was an expectation for pain to be assessed and managed when signs and symptoms were present, and for communication between nurse aides and nursing staff regarding observed pain. Despite these expectations, the resident went for an extended period without pain assessment or management, and no pain medications were ordered until much later. The lack of timely pain management and failure to implement non-pharmacological interventions constituted a deficiency in providing safe and appropriate pain management for the resident.