Failure to Provide Effective Pain Management and Non-Pharmacological Interventions
Penalty
Summary
The facility failed to provide effective pain management consistent with professional standards of practice for three residents reviewed for pain management. Staff did not offer non-pharmacological interventions or investigate the underlying causes of pain, as required by facility policy. The policy specified that staff should conduct comprehensive pain assessments, address underlying causes, and implement both pharmacological and non-pharmacological interventions, but these steps were not followed. One resident with a neurological condition, feeding tube, and indwelling catheter experienced pain related to kidney stones and catheter issues. The care plan did not address the resident's history of kidney stones or include interventions for this pain. Despite receiving narcotic pain medication, the resident reported ongoing pain, and staff did not offer alternative interventions or promptly assess the cause, which was later found to be a kinked catheter. Staff interviews confirmed that non-pharmacological interventions were missing from the care plan and medication record, and that pain assessment was inadequate. Another resident with a right arm fracture and a third resident with a leg fracture both received pain medications, but their care plans and medication records lacked documentation of non-pharmacological interventions. Staff provided medications without specifying the type or location of pain and did not document or offer alternative pain relief methods. Staff interviews confirmed that non-pharmacological interventions were not included or documented, and that pain assessments and care plans were incomplete.