Failure to Provide Timely Pain Medication and Specialist Referral
Penalty
Summary
The facility failed to ensure that a resident requiring narcotic pain management had uninterrupted access to prescribed medications and appropriate specialist care. The resident, who had diagnoses including anxiety, depression, paraplegia, and chronic pain, was admitted with orders for morphine extended release and oxycodone for chronic pain. After admission, the resident received 11 doses of morphine, but then went without the medication for six days due to the facility's inability to refill the prescription. This lapse occurred because the resident's attending physician ended their service on April 30th, and the facility had not secured a replacement physician to continue care and authorize prescriptions. During the period without morphine, the resident's pain increased, with self-reported pain levels rising from a manageable five to as high as seven or eight out of ten. The resident attempted to obtain the medication by visiting the emergency room multiple times, but was unable to receive a prescription there, as the ER would not provide PRN medications. Facility staff, including nurses and medication aides, confirmed that there was confusion regarding who was responsible for ordering the narcotic medication and that pain levels were not consistently assessed or documented during this period. The medication administration record reflected the missed doses, and staff interviews revealed a lack of clarity about the resident's attending physician and the process for medication refills. Additionally, the resident requested a referral to a pain management specialist, but this request was not acted upon. The social service director, who was responsible for arranging outside services, was not informed of the resident's request, and no referral was made. Communication breakdowns among staff, lack of physician coverage, and inadequate documentation and monitoring of pain contributed to the resident experiencing increased pain and a gap in pain management services.