Failure to Notify Physician of Resident’s Severe Uncontrolled Pain and Medication Unavailability
Penalty
Summary
The deficiency involves the facility’s failure to notify a resident’s physician of a significant change in condition, specifically severe, uncontrolled post-surgical pain, and the unavailability of ordered pain medications. The resident had recently undergone a left total knee replacement and was admitted for post-surgical pain control with multiple prescribed pain medications, including Hydrocodone, Hydromorphone (Dilaudid), Morphine, and Tizanidine. Hospital discharge instructions directed staff to call the physician for any severe, uncontrolled pain. Upon admission, the resident was cognitively intact, required one-person assist with a walker, and had chronic pain, morbid obesity, and left knee osteoarthritis status post total knee arthroplasty. The hospital report indicated that controlled substance prescriptions were sent with the discharge packet and that the resident had last received Dilaudid at 4:00 p.m. prior to transfer. According to nursing documentation, by 1:10 a.m. the resident’s prescribed pain medications had not been delivered by the pharmacy and were not available in the facility’s emergency medication supply. At approximately 1:00 a.m., the resident was tearful, shaking, and stated she could not wait any longer for pain medication, requesting transfer to the emergency room. The progress note did not document any physician notification. The LPN caring for the resident overnight confirmed that the resident complained of severe left knee pain multiple times between 11:00 p.m. and 1:00 a.m., had not received any pain medication since admission, and that the LPN did not notify a physician about the severe pain, the lack of available ordered pain medications, or the resident’s request to go to the emergency room because she was unsure who the resident’s physician was. The Regional Nurse confirmed that nursing staff should have notified the physician when the resident’s pain became severe, when ordered pain medications were unavailable, and when the resident was transferred to the hospital. The facility’s policy required physician notification for significant changes in condition and when a decision is made to transfer a resident from the facility.
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