Failure to Provide Timely Pain Management Due to Medication Order Gap
Penalty
Summary
A deficiency occurred when a resident with multiple pain-related diagnoses, including polyneuropathy, trigeminal neuralgia, paraplegia, and chronic pain, did not receive appropriate pain management as ordered. The resident's care plan included a routine pain medication regimen, specifically Lyrica, to manage neuropathic pain. On a specified date, the physician discontinued the resident's existing Lyrica 75 mg order in the late afternoon and issued a new order for Lyrica 100 mg to begin the following morning. This resulted in the resident not receiving her scheduled evening dose of Lyrica. During the evening, the resident reported severe pain and inquired about her medication. The evening nurse confirmed that the new order was not available for administration at that time and reported the issue to the supervisor. The resident continued to experience pain until the new Lyrica order was entered and administered later that night. The DON confirmed that the medication was not administered on time, resulting in a lapse in pain management consistent with professional standards of practice.