Failure to Ensure Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide safe and appropriate pain management for several residents, as evidenced by staff interviews and record reviews. For one resident with diagnoses including cerebral palsy, COPD, diabetes, and epilepsy, physician orders specified the use of acetaminophen for pain and morphine for moderate to severe pain, with non-pharmacological interventions listed. However, documentation showed morphine was administered for pain levels below the moderate threshold, and nursing staff did not consistently document the location or description of pain, nor the use of non-pharmacological interventions, as required by the care plan and professional standards. Another resident with pneumonia and generalized weakness had physician orders for Tylenol for mild pain and oxycodone for moderate to severe pain. Medication administration records revealed oxycodone was given for pain scores below the ordered parameters, including for scores of zero, two, and three, and Tylenol was administered for higher pain scores. The DON confirmed that staff did not follow the physician's pain scale parameters for medication administration. A third resident with multiple sclerosis, contractures, and chronic pain syndrome had orders for oxycodone as needed for pain and acetaminophen for mild pain, but without specific parameters for oxycodone use. Records showed oxycodone was administered for low pain levels, and acetaminophen was not used, despite being ordered for mild pain. The DON acknowledged the lack of established parameters and inappropriate administration of pain medication for this resident.