Failure to Monitor for Opioid Side Effects After Dose Increase
Penalty
Summary
The facility failed to monitor for adverse side effects of opioid medications following an increased dose for a resident admitted for rehabilitation after a right hip fracture. The resident had multiple diagnoses, including Parkinson's disease, diabetes mellitus, depression, and stage 3 chronic kidney disease. The resident was prescribed several pain medications, including hydrocodone-acetaminophen, naproxen, oxycodone-acetaminophen, and later, morphine sulfate extended-release. There were no documented orders to monitor for side effects of these pain medications, despite the addition of morphine and the resident's complex medical history. Medication administration records showed frequent administration of multiple pain medications, including the new morphine order. Nursing notes indicated that the resident's power of attorney (POA) and family were not notified of the medication changes, despite facility policy and the resident's moderate cognitive impairment. The POA reported not being informed about the new morphine order and requested that the medication be held, but the resident received the morphine as ordered. Documentation of monitoring for adverse effects was lacking, and there were no notes or assessments between the last pain assessment and the time the resident was found deceased. Interviews with staff revealed inconsistent practices regarding notification of the POA and monitoring for side effects after opioid administration. While some staff stated that monitoring and notification were standard practice, there was no documentation to support that these actions were taken in this case. The facility's policy required monitoring for adverse side effects, but this was not documented or consistently performed for the resident after the opioid dose increase.