Failure to Provide Timely and Adequate Pain Management
Penalty
Summary
A deficiency occurred when a newly admitted resident with chronic pain and a physician's order for PRN Oxycodone IR 10 mg every six hours did not receive adequate and timely pain management. Upon admission, the resident requested pain medication, but the admitting nurse informed the resident that only acetaminophen was available and that obtaining oxycodone from the pharmacy would take time. The nurse attempted to access the emergency medication kit (Cubex) but only administered one 5 mg tablet of oxycodone instead of the ordered 10 mg dose, due to not completing the removal process for the second tablet. The nurse did not document the administration of this medication or the resident's pain assessment in the medical record. The resident did not receive any further oxycodone until approximately 16 hours later, despite having a physician's order for PRN administration every six hours for severe pain. During this period, the resident reported severe pain to a family member and staff, and was only given acetaminophen and topical diclofenac at one point. Documentation in the medical record was inconsistent, with conflicting times recorded for medication administration between the electronic MAR and the handwritten narcotic log. Additionally, the resident's pain level was documented as 10, the highest level, at the time oxycodone was finally administered. Interviews with facility staff revealed that the nurse did not follow proper procedures for accessing and documenting controlled substances, and that there was a lack of communication regarding medication availability and administration. The unit manager confirmed that the nurse failed to access the Cubex correctly and did not document the administration of oxycodone. The DON stated that it was expected for medications to be available and administered as ordered, and that nurses had access to the Cubex for this purpose. The failure to provide timely and appropriate pain management, as well as the lack of documentation and communication, led to the resident experiencing unmanaged severe pain.