Failure to Provide Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide safe and appropriate pain management for three residents, as evidenced by review of clinical records, interviews, and facility policy. For one resident with cerebrovascular disease and scoliosis, there were multiple instances where prescribed oxycodone was not administered due to the medication being unavailable and awaiting pharmacy delivery. Documentation showed that the medication was not reordered in a timely manner, and the in-house emergency supply was not utilized as expected. The Director of Nursing confirmed that management was not made aware of the need for a refill, and the responsible LPN did not follow procedures to ensure continuity of pain medication. Another resident, who required assistance with personal care and had muscle weakness and unsteadiness, reported ongoing back pain that was not adequately relieved by current medication. Although a nurse practitioner documented a plan to use an ice pack for pain relief, there was no corresponding physician order or care plan entry for this intervention. The resident's care plan also lacked a comprehensive approach to pain management, and the Director of Nursing acknowledged that the expected process for ordering and documenting non-pharmacological interventions was not followed. A third resident, admitted with a right humerus fracture and scalp laceration, reported that her pain was not managed to her comfort level. Her care plan did not specify her desired pain goal, and there were missed doses of acetaminophen without documentation or physician notification. The resident refused topical pain patches on several occasions, but there was no documentation of the reasons for refusal or physician notification. Additionally, non-pharmacological interventions were not documented prior to administration of as-needed pain medication, and ongoing reports of severe pain were not promptly communicated to the physician or nurse practitioner. The resident's pain management regimen was not adjusted despite continued complaints of inadequate pain control.