Failure to Administer PRN Pain Medications According to Physician Orders
Penalty
Summary
The facility failed to ensure that residents were free from unnecessary medication administration, specifically regarding the use of PRN pain medications. Licensed nurses administered pain medications prescribed for severe pain to three residents, even when their assessed pain levels were only mild to moderate. This was not in accordance with the physician's orders, which specified different medications and dosages based on the severity of pain as measured by a standardized pain scale. For example, one resident with chronic pain syndrome and diabetes received Hydrocodone-Acetaminophen and Tramadol for pain levels reported as 3 out of 10, despite these medications being ordered for moderate to severe pain. Another resident with a history of muscle weakness, liver failure, and recent spinal surgery was administered two tablets of Oxycodone for pain levels of 3 or 4 out of 10, even though the physician's order specified this dosage only for severe pain. A third resident with multiple fractures and chronic pain was also given Hydrocodone-Acetaminophen for pain scores below the threshold indicated in the physician's order. Interviews with nursing staff confirmed that PRN pain medications were to be administered according to the pain scale and physician's orders, and that deviations from this practice could result in medication errors. Facility policies and procedures reviewed during the survey also required adherence to the pain scale and physician's orders when administering PRN medications. Despite these policies, the records showed repeated instances where higher doses or stronger medications were given for lower pain scores than prescribed.