Failure to Implement Non-Pharmacological Interventions and PRN Pain Medication Parameters
Penalty
Summary
The facility failed to implement non-pharmacological interventions (NPI) prior to administering as needed (PRN) pain medications for four out of five residents reviewed, and did not provide clear parameters for the use of pain medications for one resident. For multiple residents with complex medical histories, including stroke, diabetes, COPD, fractures, hypertension, anxiety, depression, hemiplegia, and end-stage renal disease, provider orders required staff to attempt NPI such as repositioning before giving PRN pain medications. However, medication administration records (MAR) showed that NPI were not attempted or documented prior to the administration of PRN narcotic and non-narcotic pain medications. Interviews with staff confirmed that NPI were not consistently provided or documented as required by provider orders and facility expectations. Additionally, for one resident, provider orders for multiple PRN pain medications did not specify which medication should be used for different levels of pain, and there was no pain scale included to guide nursing staff in medication selection. This resulted in the resident receiving PRN pain medications without the use of NPI and without clear instructions for medication choice based on pain severity. Staff interviews further confirmed that the lack of NPI and absence of a pain scale for PRN medications did not meet facility expectations. These findings were based on record reviews, MAR audits, and staff interviews, and were cited under WAC 388-97-1060(3)(k)(i).