Failure to Provide Pain Management During Dressing Change
Penalty
Summary
A deficiency occurred when a resident with a chronic unstageable pressure ulcer on the left heel did not receive appropriate pain management during a dressing change procedure. The resident, who had a history of multiple medical conditions including recent fractures, atrial fibrillation, coronary artery disease, congestive heart failure, hypertension, dementia, and a significant pressure ulcer, was observed to experience significant pain during the dressing change. Despite having an as-needed order for hydrocodone-acetaminophen for pain, no pain assessment was conducted prior to the procedure, and pain medication was not administered before or during the dressing change, even as the resident exhibited clear signs of pain such as facial grimacing, increased breathing rate, shifting position, and verbal expressions of discomfort. During the observed dressing change, the staff involved were not familiar with the resident's wound care orders or pain management needs. The nurse and unit manager present did not assess the resident's pain before starting the procedure and proceeded with the dressing change despite the resident's repeated verbal and non-verbal indications of pain. The surveyor had to intervene and suggest pain medication, but the dressing change was completed before the medication was administered. The resident later rated his pain as an 8 out of 10 during the procedure. Interviews with staff, including the nurse, unit manager, DON, administrator, and nurse practitioners, confirmed that the expected practice was to assess and manage pain during such procedures. The staff involved acknowledged that pain management was not provided as it should have been, and the nurse admitted to being focused on the wound care rather than the resident's comfort. The deficiency was identified through direct observation, record review, and interviews, highlighting a failure to provide safe and appropriate pain management during a painful procedure.