Lack of Clear Parameters for PRN Pain Medication Orders
Penalty
Summary
The facility failed to provide pharmaceutical services that ensured the accurate administration of medications for a resident with dementia and muscle weakness. Specifically, the resident had two PRN orders for Tramadol 50mg—one for 1 tablet and one for 2 tablets every 6 hours as needed for pain—without clear parameters or indications for when each dose should be administered. The medication administration record showed that the 1-tablet dose was given multiple times for varying pain levels, but the 2-tablet dose was never administered. Nursing staff reported uncertainty about when to use each order, and the orders lacked specific pain scale parameters to guide administration. The facility's pain management policy required monitoring and following physician orders, but the orders themselves were not sufficiently detailed to ensure proper administration. Interviews with staff revealed that nurses were unsure about the correct circumstances for administering the different PRN doses, and the pharmacist acknowledged that including pain scale parameters would be best practice. The physician clarified that the orders should have specified 1 tablet for pain levels 1-4 and 2 tablets for pain levels 5-10, but this was not reflected in the orders as written or transcribed. The lack of clear parameters in the PRN orders led to inconsistent administration practices and potential confusion among staff.