F0697

D

Failure to Administer and Reassess PRN Pain Management for Fracture-Related Pain

Glendale, California Survey Completed on 01-22-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide effective pain management for one resident with multiple right foot and ankle fractures and dislocations. The resident was admitted with diagnoses including displaced fracture of the anterior process of the right calcaneus, fracture of the right talus, fracture of the scaphoid of the right foot, and dislocation of the tarsometatarsal joint of the right foot. The resident’s history and physical documented that he had capacity to understand and make decisions, and his MDS indicated he had occasional pain. Physician orders directed staff to monitor pain every shift using a 0–10 pain scale, implement non-prescription behavioral interventions every shift with documentation of effectiveness, and administer PRN pain medications: Lyrica 100 mg for severe pain (7–10), Tramadol 50 mg twice daily PRN for moderate pain (4–6), and Tylenol 325 mg twice daily PRN for mild pain (1–3). The care plans for fracture-related conditions and risk for pain required staff to administer medications as ordered, assess pain intensity, monitor pain characteristics and side effects, and evaluate and document the effectiveness of pain interventions.

On a specific date in January, the MAR showed that during the 7 AM to 3 PM shift the resident reported pain at 8/10. Documentation indicated that only non-pharmacological interventions—reassurance, diversion, redirection, verbal cues, and reassuring—were provided by an LVN. No PRN pain medication was administered despite the order for Tramadol for pain levels 7–10, and there was no documented reassessment of the effectiveness of the non-pharmacological interventions. The MAR for that date and shift contained no entry showing that the resident’s pain was reevaluated after these interventions. Review of the MARs from December through January confirmed that on that date no pharmacological intervention was provided and no reevaluation was documented for the high pain score.

In interviews, the resident reported ongoing right ankle pain and swelling and stated that when he reported pain to nursing staff, they did not provide pain medication and that his pain was not being taken seriously. The LVN involved stated she was not informed that the resident was experiencing pain and also stated that the treatment nurse monitored residents for pain; she later explained that she provided non-pharmacological interventions first when a resident reported pain and acknowledged she had not documented their effectiveness. The RN supervisor confirmed that no pharmacological intervention or reassessment was documented for the 8/10 pain episode and stated that pain medication such as Tramadol should have been administered. The DON also confirmed that there was no reevaluation documented for the non-pharmacological interventions and stated that if the resident still had pain after such interventions, pain medications should have been given. The resident expressed a preference for pain medications over non-pharmacological interventions, stating that the latter did not relieve his pain and that he felt no one cared about his pain. The facility’s pain assessment and management policy required appropriate assessment and treatment of pain and monitoring for the effectiveness of interventions.