F0697

D

Failure to Assess and Manage Pain During Incontinence Care

Lemont, Illinois Survey Completed on 08-21-2025

Penalty

Fine: $22,260

Summary

The deficiency involves the facility’s failure to adequately assess and manage pain for a resident with a recent left femur fracture and dementia who experienced significant pain during routine care. The resident was admitted with a diagnosis of left femur fracture and post-surgical care, with documentation that she felt pain when turning and complained of left hip pain with movement. Physician orders included monitoring pain level and location each shift and multiple PRN and scheduled analgesic orders, including acetaminophen and hydrocodone-acetaminophen for moderate to severe pain. The care plan documented that the resident was on pain medication therapy related to pain, with an intervention to administer analgesics as ordered.

On the observed date, a CNA reported that the resident screamed and yelled when touched, and surveyors observed the resident screaming and yelling in pain and calling for help during incontinence care. The resident’s meal tray remained untouched because she declined to have her bed raised due to pain and preferred not to be moved. The CNA stated she had asked the nurse about pain medication, and the nurse initially told her she did not know if the resident had any medication orders. The nurse later stated she was waiting for the CNA to finish incontinence care before administering pain medication, despite the resident’s active pain medication orders. The DON stated that when a resident exhibits significant pain during incontinence care, the nurse should assess the pain, medicate prior to care if possible, and, if the resident cannot tolerate care, wait and re-approach after pain is addressed. The facility’s policies on ADLs and pain management require recognizing and evaluating pain, anticipating pain with activities such as repositioning, and pre-medicating when possible, which was not done in this case.