Failure to Follow PRN Pain Medication Orders for Severe Pain
Penalty
Summary
The deficiency involves the facility’s failure to administer pain medication according to physician orders for one resident. The resident was admitted with diagnoses including orthopedic aftercare, unspecified COPD, and acute and chronic respiratory failure with hypoxia. An H&P dated 12/19/2025 indicated the resident did not have capacity to understand and make decisions, while an MDS dated 12/25/2025 documented intact cognitive skills for daily decisions, a need for supervision with hygiene, toileting, and showering, and occasionally moderate pain. Physician orders dated 1/15/2026 directed that hydrocodone-acetaminophen 5-325 mg be given every four hours as needed for moderate pain rated 4–6, and oxycodone-acetaminophen 7.5-300 mg be given every six hours as needed for severe pain rated 7–10. Review of the MAR for January 2026 showed that LVN 2, LVN 3, and LVN 4 administered hydrocodone instead of the ordered oxycodone when the resident’s pain was documented at levels 7 or 8 on four separate occasions (1/21/2026 at 2:27 a.m., 1/25/2026 at 6:28 a.m., 1/26/2026 at 1:10 a.m., and 1/29/2026 at 3:10 a.m.). During interviews, the ADON confirmed that the physician’s order specified hydrocodone for pain levels 4–6 and oxycodone for pain levels 7–10, and acknowledged that the nurses should have administered oxycodone instead of hydrocodone on those dates. The DON also stated that nurses are expected to follow physician orders and that the resident’s pain could not be completely relieved because the orders were not followed. Review of facility policies on Pain Assessment and Management and Administering Medications showed that medications are to be implemented and administered as ordered, including required time frames.
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