Failure to Provide Safe and Appropriate Pain Management
Penalty
Summary
The facility failed to provide pain management consistent with professional standards of practice and the residents' goals and preferences for multiple residents. For one resident with diagnoses including cirrhosis of the liver, ankylosing spondylitis, diverticulitis, generalized abdominal pain, and osteoarthritis, the facility did not ensure that licensed nurses assessed and documented the resident's pain level using a numeric pain rating scale, the location of pain, or the use of non-pharmacological interventions prior to administering oxycodone as ordered. Review of the Medication Administration Record (MAR) and progress notes revealed numerous instances where these required assessments and interventions were not documented, despite facility policy and physician orders mandating such documentation. The resident reported ongoing abdominal pain and dissatisfaction with the effectiveness of the pain medication provided. Another resident with a history of spinal fusion, rheumatoid arthritis, and pain due to internal orthopedic prosthetic devices was not administered PRN oxycodone 10 mg according to the physician's orders, which specified its use for severe pain (pain scale 7-10). Instead, the medication was given for pain levels below the threshold indicated in the order. Additionally, there was a discrepancy in the orders for oxycodone 5 mg, which was also prescribed for pain levels 7-10, a range typically associated with severe rather than moderate pain. This order was not clarified with the physician prior to administration, and the medication was given for pain levels that did not match the intended severity, as documented in the MAR. A third resident with new onset bilateral shoulder pain did not receive a timely assessment of the pain or administration of a lidocaine patch as ordered. The facility's policies and procedures, which require consistent pain assessment, documentation, and implementation of both pharmacological and non-pharmacological interventions, were not followed. Interviews with nursing staff and the Director of Nursing confirmed that these lapses in documentation and order clarification occurred, and that the facility's pain management protocols were not adhered to during the period reviewed.