Failure to Provide Timely and Appropriate Pain Management
Penalty
Summary
The facility failed to provide appropriate pain management for two residents who required such services. One resident, admitted from the hospital with a femur fracture and other conditions, was cognitively intact and had physician orders for multiple pain and anxiety medications, including oxycodone. Upon admission, there was a significant delay in entering and obtaining medication orders, resulting in the resident not receiving prescribed pain medications, muscle relaxants, and psychotropic medications in a timely manner. Staff interviews revealed confusion and lack of communication regarding the arrival and administration of medications, with the resident experiencing severe pain and only receiving pain medication once during the night. Staff interactions with the resident were marked by raised voices and inappropriate language, and the resident ultimately left the facility with family after not receiving adequate pain relief. Another resident with acute osteomyelitis and chronic pain was admitted and required both scheduled and as-needed pain medications. The care plan directed staff to administer analgesics per orders and prior to treatments. However, after the nurse practitioner documented an order for as-needed oxycodone following a report of severe pain, there was a delay in transcribing and initiating this order. The resident reported that pain was unbearable upon arrival and only improved after the correct pain medication order was implemented. Staff interviews confirmed that the as-needed order was not promptly processed, resulting in inadequate pain control for several days. The deficiencies were directly related to failures in timely transcription, communication, and administration of physician-ordered pain medications. Documentation and staff statements confirmed that both residents experienced unnecessary pain due to these lapses, and the facility did not follow its own policy for pain management, which requires prompt assessment, documentation, and intervention to maintain resident well-being.