Failure to Provide Timely Pain Medication for Residents
Penalty
Summary
The facility failed to provide appropriate pain management for three residents who required such services, resulting in periods where prescribed pain medications were not available or administered as ordered. One resident with severe cognitive impairment and a diagnosis of polyneuropathy had a physician order for hydrocodone-acetaminophen to be given as needed for pain. Documentation showed that this medication was not administered for several days, despite pain assessments indicating moderate pain levels. Staff interviews confirmed that the resident was out of pain medication for over a week, during which time alternative medications like acetaminophen were offered but did not relieve the pain. The resident was observed to cry in pain, and staff were unsure why the medication was unavailable. Another resident with multiple sclerosis and moderate cognitive impairment had a physician order for gabapentin to be administered at bedtime. Medication administration records indicated that the resident did not receive gabapentin for about a week, with staff noting that the resident cried at night due to untreated pain. The lack of medication was attributed to issues with obtaining prescriptions from the physician, and staff were unclear about the reasons for the delay. Pain assessments during this period showed low but present pain levels, and staff interviews confirmed the resident's discomfort during the time the medication was unavailable. A third resident with polyneuropathy and intact cognition had a physician order for Lyrica to be administered twice daily. Medication records showed multiple instances where the medication was not available and not administered, with staff documenting this using a specific chart code but failing to provide corresponding progress notes as required by facility policy. Pain assessments indicated that the resident experienced pain on several days when the medication was not given. Staff interviews revealed ongoing issues with medication availability, particularly for controlled substances, due to challenges with pharmacy supply, physician prescription practices, and regulatory requirements for controlled substances.