Failure to Provide Adequate Pain Management During Wound Care
Penalty
Summary
Facility staff failed to implement appropriate pain management interventions during wound care for a resident with a stage four pressure ulcer. The resident, who had diagnoses including depression, osteoarthritis, and chronic pain, was admitted with a significant sacral wound and had a history of almost constant pain, frequently rated as severe. The resident's care plan included both scheduled and as-needed pain medications, specifically acetaminophen and oxycodone, and the facility's policy required staff to anticipate, evaluate, and manage pain in accordance with the resident's assessment and plan of care. On the day of the observed incident, the resident received scheduled acetaminophen and a PRN dose of oxycodone several hours before a negative pressure wound therapy (NPWT) dressing change. During the procedure, the resident exhibited clear signs of pain, including yelling, crying, facial grimacing, and verbalizing distress. Despite these indications, the staff performing the wound care did not pause the procedure to assess the resident's pain or offer additional pain relief. Instead, they continued the treatment while providing only verbal encouragement and distraction techniques. Interviews with staff confirmed that the procedure was known to be painful and that the resident was in significant distress during the dressing change. The Assistant Director of Nursing acknowledged that a PRN dose of oxycodone should have been administered prior to the treatment but was not. The resident later reported experiencing pain at the highest level during the procedure and stated that staff did not offer the option to stop the treatment or address the pain further.