Failure to Provide Timely and Appropriate Pain Management
Penalty
Summary
A deficiency occurred when a resident with chronic pain syndrome, migraines with aura, and other medical conditions did not receive appropriate pain management services as ordered. The resident had a physician's order for Oxycodone 5 mg every 6 hours as needed for pain, but the medication was not available in the facility for an extended period. Documentation showed that the resident was only administered a limited number of Oxycodone tablets shortly after admission, and there was no evidence of the medication being provided during the month of September, despite ongoing reports of pain rated as high as 7 out of 10. The pharmacy records confirmed that the Oxycodone prescription was not filled or delivered until much later, and the facility's medication administration records and narcotic count sheets corroborated the lack of availability. On one occasion, the resident complained of severe abdominal pain and requested her prescribed pain medication, but staff were unable to provide it due to its unavailability. The nurse offered Tylenol, which the resident refused, and the resident subsequently requested to be transferred to the emergency room for pain management. Progress notes indicated that staff did not complete a pain assessment at the time of the complaint, nor did they contact the nurse practitioner or physician in a timely manner to resolve the medication issue. Interviews with staff revealed confusion and lack of clarity regarding the process for obtaining triplicate prescriptions for controlled substances, and there was no evidence that the necessary steps were taken to ensure the resident's pain medication was available as ordered. The facility's own policies required comprehensive pain assessments and prompt interventions consistent with professional standards of practice and the resident's care plan. However, these procedures were not followed, as evidenced by the lack of pain assessments, failure to monitor the effectiveness of interventions, and inadequate communication with providers and pharmacy. The deficiency resulted in the resident experiencing unmanaged pain and requiring emergency transfer for pain relief.