Failure to Provide Ordered Pain Management and Notify Physician
Penalty
Summary
A resident with a diagnosis of arthritis affecting multiple sites, including a pinched nerve in the neck, reported ongoing neck pain and was prescribed a Lidocaine 4% patch to be applied to the left posterior neck each morning for ten days. Despite this physician order, the resident did not receive the pain patch for at least two consecutive days, as confirmed by both the resident's statement and review of the Medication Administration Record (MAR), which indicated the medication was unavailable on one of those days. Nursing notes documented the resident's complaint of pain but did not show that any non-pharmacological interventions were attempted to relieve the pain. Further review of the resident's care plan revealed instructions to administer medications as ordered, monitor for effectiveness and side effects, and report to the physician as indicated. However, there was no documentation that the physician was notified about the unavailability of the pain medication or that alternative pain management strategies were implemented. The Director of Nursing confirmed that the physician should have been notified in such situations, but this was not done, and no non-pharmacological interventions were documented.