Failure to Attempt Non-Pharmacological Pain Interventions Before Administering Narcotics
Penalty
Summary
The facility failed to follow its own pain management policy by not attempting non-pharmacological interventions before administering a narcotic pain medication to a resident. According to the facility's policy, non-pharmacological methods such as repositioning, relaxation techniques, or heat/cold therapy should be tried prior to giving a PRN (as needed) pain medication, and pain intensity should be documented. However, review of the clinical record for a resident with diagnoses including COPD and a bladder neoplasm showed that Oxycodone, a narcotic, was administered on multiple occasions without any documentation of attempted non-pharmacological interventions or assessment of pain level before or after administration. The resident was cognitively intact, as indicated by a BIMS score of 13, and had physician orders for both Acetaminophen and Oxycodone for pain management. The orders did not specify pain intensity levels for Acetaminophen, and for Oxycodone, it was to be used for severe pain. Despite this, the electronic Medication Administration Record (eMAR) showed that Oxycodone was given several times in September without any record of pain assessment or use of non-pharmacological interventions, contrary to facility policy. This was confirmed during an interview with the Nursing Home Administrator.