Failure to Provide Adequate Pain Management Following Resident Injury
Penalty
Summary
A deficiency occurred when a resident with a history of osteoporosis, osteopenia, atherosclerosis, and prior bone demineralization experienced severe pain following a transfer using a mechanical lift. The resident began screaming in pain during the transfer, repeatedly stating that her arm was broken. Multiple CNAs responded to the resident's distress, and the incident was reported to the LPN on duty. Despite the resident's complaints and visible distress, the initial nursing assessment did not identify any dislocation or swelling, and the resident was administered acetaminophen as ordered for pain rated at nine out of ten. The post-administration pain level was documented as seven, but the time of reassessment was not recorded, and no further interventions were documented to address the ongoing pain. The resident continued to complain of severe pain for several hours, with staff interviews confirming that the resident was left in pain and that the nurse did not promptly reassess or provide additional interventions. The physician was not notified until approximately three hours after the initial complaint, at which point an order was given to send the resident to the emergency room. Upon arrival at the hospital, the resident was found to have a new, acute displaced transcondylar humerus fracture, which required immobilization and narcotic pain medication. The facility's pain management policy required documentation of pre- and post-pain levels, timely reassessment, and the use of non-pharmacological interventions, none of which were fully implemented in this case. Staff interviews revealed a lack of timely response and follow-up to the resident's pain complaints, with CNAs reporting the incident to the nurse and the nurse delaying assessment and intervention. The DON was unaware of any follow-up or reassessment after the initial administration of pain medication. The failure to provide adequate pain management and timely medical intervention resulted in actual harm to the resident, as evidenced by the prolonged period of severe pain and the need for emergency medical care.