Failure to Provide Timely and Appropriate Pain Management
Penalty
Summary
A deficiency occurred when the facility failed to provide safe and appropriate pain management for a resident with chronic pain and multiple complex medical conditions, including acute respiratory failure, tracheostomy status, dysphagia, chronic pain, and end-stage renal disease. The resident had a physician's order for Hydrocodone-Acetaminophen to be administered as needed for pain, but the medication was not reordered in a timely manner, resulting in the resident running out of the medication and experiencing excruciating pain for two days. During this period, the resident repeatedly requested pain relief and ultimately requested to be sent to the emergency room due to unrelieved pain. The resident's responsible party reported that the resident was crying and in severe distress due to lack of effective pain control. Documentation failures were also identified, as the resident's medication administration record (MAR) did not match the narcotic count sheet for PRN Hydrocodone, raising concerns about accurate medication administration and record-keeping. Additionally, the facility did not consistently assess or document the effectiveness of PRN Hydrocodone after administration, as required by physician orders and facility policy. Interviews with nursing staff revealed that documentation was sometimes missed due to being busy, and that pain assessments following PRN administration were not consistently performed or recorded. The nurse practitioner and director of nursing both stated that they were not notified in a timely manner about the resident's medication running low, and that the order for PRN Hydrocodone was not appropriate for the resident's needs in the facility setting. The facility's policies required timely reordering of medications, accurate documentation, and follow-up assessment of pain management interventions, but these were not followed. These failures led to the identification of Immediate Jeopardy by surveyors, as the resident was left without effective pain management and required transfer to the hospital for pain control.