Failure to Coordinate Timely Hospice Pain Management for Resident with Wound Infection
Penalty
Summary
The facility failed to ensure effective communication and coordination of care with the hospice provider for a resident with advanced dementia, cerebral infarction, malnutrition, and immunodeficiency who was receiving hospice services. The resident developed a wound infection, and the wound physician performed an incision and drainage, recommending pain medication stronger than acetaminophen. However, the wound physician did not prescribe additional pain medication, citing the resident's hospice status, and deferred to hospice for pain management. Nursing staff attempted to contact the hospice provider's on-call services on two consecutive days to request an evaluation for stronger PRN pain medication, but no hospice nurse responded or visited the facility during that period. Documentation from the hospice provider indicated no record of calls from the facility during the relevant dates. The resident continued to receive only acetaminophen for pain, despite documented severe pain during dressing changes, as assessed by nursing staff using a behavioral pain scale. It was not until several days later that a hospice nurse visited, assessed the resident, and ordered morphine and Ativan for pain and anxiety management. The lack of timely communication and coordination between facility staff and the hospice provider resulted in a delay in appropriate pain management for the resident, contrary to the care plan interventions and the facility's agreement with the hospice provider.