Failure to Provide Timely and Appropriate Pain Management
Penalty
Summary
The facility failed to ensure timely and appropriate pain management for a resident with a history of cognitive impairment, dementia, depression, anxiety, and a recent left femur fracture. The resident experienced multiple falls, including one unwitnessed fall where he was found on the floor, unable to stand, and complaining of left hip pain. Despite a care plan identifying the resident as at risk for pain and discomfort, and physician orders for acetaminophen suppositories for pain, staff did not administer pain medication as ordered following the fall and during subsequent reports of pain. After the fall, the resident was given acetaminophen 325 mg, which was ordered only for fever, not for pain, and not the prescribed acetaminophen suppository for pain. The resident continued to report pain and had difficulty with activities of daily living, but no pain medication was administered from the day after the fall until two days later, despite ongoing complaints. It was only after further assessment and review of hospital records, which revealed a new hip fracture, that a stronger pain medication (oxycodone) was ordered and administered. Interviews with facility staff confirmed that pain management interventions were not implemented as per the care plan and physician orders. The CNP was unaware that acetaminophen had not been used for pain, and the DON verified that nursing staff did not attempt to give the prescribed pain medication during the period when the resident was experiencing pain. Facility policy required timely assessment and management of acute pain, but this was not followed in the resident's case.