Failure to Provide Timely Pain Management for Resident With Rib Fractures
Penalty
Summary
The facility failed to provide timely pain management for a resident admitted for rehabilitation and pain control following multiple traumatic rib fractures. The resident reported having been discharged from the hospital on intravenous hydromorphone and described their pain as “20 out of 10” upon admission. Vital signs documented the resident’s pain as 8/10 at 1:00 PM and again at 5:44 PM. Despite this, the Medication Administration Record shows the first dose of pain medication was not administered until 6:49 PM, resulting in the resident waiting approximately 7.5 hours for pain medication. During this period, the resident reported being in severe pain, stating they could not even open the door to their room and ultimately called a friend to pick them up and left the facility. Staff interviews revealed that the admitting RN stated the resident arrived during medication pass, and that she needed to finish the pass before entering the resident’s orders, noting that the admission made the already challenging hall more difficult. She acknowledged not entering the orders quickly enough and that the facility did not have the resident’s pain medication on hand, leading to a delay of several hours before treatment. The NP reported assessing the resident later that afternoon, with the resident rating pain at 9/10 and having multiple left rib fractures from ribs 6 to 9, with primary diagnoses of rib fracture and pain. The NP stated they were not notified that the ordered pain medications were unavailable until around 6:00 PM and indicated that, had they been informed earlier, an alternative pain medication would have been provided immediately. The facility’s own pain management policy defined acute pain as pain caused by injury or trauma and stated its purpose was to help residents attain or maintain their highest practicable well-being and to prevent or manage pain, which was not followed in this case.
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