Failure to Specify Pain Scale Parameters in PRN Pain Medication Orders
Penalty
Summary
The facility failed to ensure proper pain management for two residents by not including pain scale parameters in their PRN pain medication orders. One resident, who had recently returned from a general acute care hospital following a right hip hemiarthroplasty, had physician orders for Tramadol and Tylenol, both as routine and PRN, but the PRN Tramadol order did not specify the pain scale (mild, moderate, or severe) for administration. Interviews with nursing staff and the Director of Nursing confirmed that the absence of pain scale parameters could lead to inappropriate administration of pain medication, as the medication could be given for any reported pain level, potentially resulting in overmedication or undermedication. Another resident with diagnoses including dementia, muscle weakness, and chronic right hip pain also had PRN orders for Tylenol Extra Strength and Tramadol without pain scale parameters. The care plan for this resident included interventions for pain management, but the medication orders did not specify which pain levels warranted the use of each medication. The Director of Nursing acknowledged during interviews that both PRN pain medications for this resident should have included pain scale parameters to guide nursing staff in appropriate administration. A review of facility policies indicated that PRN medication orders should specify the type, route, dosage, frequency, strength, and reason for administration, and that pain management should involve identifying and using specific strategies for different levels and sources of pain. Despite these policies, the orders for both residents lacked the necessary pain scale parameters, leading to a deficiency in the facility's pain management practices.