Failure to Administer PRN Pain Medication and Monitor Pain Management
Penalty
Summary
The facility failed to identify, treat, monitor, and manage pain for a resident with multiple chronic pain conditions, including rheumatoid arthritis, polymyalgia rheumatica, and chronic pain, as outlined in the resident's care plan and physician orders. Despite the resident experiencing and expressing significant pain during routine care activities such as dressing, cleaning, and transferring, staff did not administer the prescribed PRN (as needed) morphine sulfate for breakthrough pain. Observations showed the resident wincing, screaming, and flailing in pain during care, and interviews with staff confirmed that pain was reported but not adequately addressed with medication. The resident's care plan included specific interventions for pain management, such as administering pain medication per physician order for breakthrough pain and monitoring pain characteristics. However, the medication administration records indicated that while scheduled morphine was given, the PRN morphine sulfate was not administered at all during the review period, despite clear evidence of pain. Staff interviews revealed a lack of awareness regarding the resident's pain medication regimen and an absence of a system to monitor PRN medication usage. Nursing staff and management were not certain why the PRN medication was not used, and the resident was not informed that he could request pain medication when experiencing pain. Family members and staff expressed concern about the resident's uncontrolled pain, and the primary care physician was unaware that the PRN morphine was not being administered. The facility's pain management policy required a systematic approach to pain recognition, assessment, treatment, and monitoring, but this was not followed in the resident's case. The deficiency was further compounded by the lack of documentation and communication regarding the resident's pain and the absence of a process to ensure PRN pain medications were utilized as ordered.