Failure to Administer Ordered Pain Medication Prior to Wound Care
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and multiple leg wounds did not consistently receive pain management as ordered. The resident had physician orders for lidocaine cream to be applied topically to right lower extremity wounds prior to wound care, as well as PRN hydrocodone-acetaminophen for pain. Documentation showed that lidocaine cream was not always applied before wound treatments, as observed during a wound care procedure where the resident exhibited signs of pain, such as grimacing, grabbing her leg, and verbalizing discomfort. The resident also reported that there were times when wound treatments were missed or delayed, and that the medication for her wounds had run out on occasion. Interviews with nursing staff confirmed that wound care supplies, including prescription creams like lidocaine, sometimes ran out, resulting in wound care being postponed to the next shift. One LPN reported being unable to find the resident's prescribed lidocaine cream in the treatment cart, and only found an unlabeled tube in the medication cart. The Director of Nursing acknowledged that lidocaine should be applied as ordered and that each resident's medication should be labeled and supplied by the pharmacy. The attending physician stated that he expected all ordered medications and treatments to be administered as prescribed, specifically noting that lidocaine was intended to help with pain during wound care. Facility policy required the assessment and management of pain using both pharmacological and non-pharmacological interventions, consistent with the resident's care plan and physician orders. Despite these policies and orders, the resident experienced pain during wound care procedures due to the failure to consistently administer topical lidocaine as ordered, as well as issues with medication availability and administration practices.