Failure to Provide Effective Pain Management During Dressing Change
Penalty
Summary
A resident with a history of cancer, frequent pain, rheumatoid arthritis, muscle weakness, and recent major surgeries involving nephrostomy tubes and a colostomy was not provided with effective pain management during a dressing change. The resident, who was cognitively intact, had physician orders for acetaminophen and oxycodone for pain, with an acceptable pain level set at 5 out of 10. During an observed dressing change, the resident verbalized significant pain and discomfort, but the RN did not assess or acknowledge the pain prior to or during the procedure. Pain was only assessed after the dressing change, at which point the resident rated the pain as 8 to 9 out of 10 and was then administered acetaminophen per request. Interviews with staff revealed that premedication for pain prior to dressing changes was only done occasionally, and the RN admitted to sometimes proceeding with procedures despite the resident's pain and anxiety. The DON confirmed that premedication was provided only if it was within the physician's ordering timeframe. The resident later confirmed experiencing pain during the dressing change and expressed a preference for premedication prior to such procedures. Facility policy required that residents receive care in accordance with professional standards and their choices related to pain management, including assessment of both verbal and non-verbal indicators of pain.