Failure to Provide Timely Scheduled Pain Medication for Resident with Fractured Leg
Penalty
Summary
A resident with a history of multiple complex medical conditions, including a recent nondisplaced acute fracture of the proximal tibial metaphysis and severe osteopenia, did not receive scheduled pain medication as ordered. The resident's care plan included both scheduled and PRN (as needed) pain medications, with specific interventions to anticipate and respond to pain, including non-pharmacological measures. Despite these orders, the electronic Medication Administration Record (eMAR) showed a significant delay in administering the resident's scheduled hydrocodone-acetaminophen dose, which was given 3.5 hours late. On the morning of the observed deficiency, the resident was found in bed, visibly in pain, rating her discomfort as 10 out of 10, and expressing distress about her condition. The RN on duty acknowledged being delayed due to other responsibilities and only administered the scheduled pain medication after being informed by a CNA of the resident's pain. The documentation also showed that the resident had received two doses of narcotic pain medication within a short interval the previous evening, and then had a prolonged period without pain medication until the next morning. The facility's policy required timely recognition, assessment, and management of pain, including adherence to scheduled medication administration and prompt response to pain complaints. However, the failure to administer the scheduled pain medication on time, as well as the lack of immediate response to the resident's pain, resulted in the resident experiencing severe, unmanaged pain. The Director of Nursing confirmed that the delay in medication administration and the approach to pain management did not align with facility expectations or policy.