Narcotic Pain Medication Administered Outside Ordered Parameters
Penalty
Summary
The deficiency involves the facility’s failure to administer narcotic pain medication according to the physician’s ordered parameters for a resident with multiple fractures and other comorbidities. The resident was admitted with diagnoses including nondisplaced right humerus fracture, lumbar vertebral fractures, morbid obesity, fall, anxiety disorder, and alcohol use. The baseline care plan identified the resident as alert and aware, with goals for physical and occupational therapy and adequate pain control. Physician orders included PRN acetaminophen 500 mg every six hours for mild to moderate pain and PRN Roxicodone (oxycodone HCl) 5 mg every six hours for severe pain, defined as a pain level of 8–10 on a 1–10 scale. Record review showed that staff administered the PRN Roxicodone outside the ordered parameters on multiple occasions. Under the first Roxicodone order, the resident received the narcotic for pain scores of 7 on several dates and once for a documented pain level of 0, even though the order specified use only for severe pain (8–10). After the order was refilled, the resident again received Roxicodone for a pain level of 7, which was below the ordered threshold. In total, there were eight administrations under the first order and one under the second order when the resident’s pain level was below 8. Staff interviews with an LPN and an RN confirmed that the PRN narcotic was given outside the ordered parameters and that acetaminophen, ordered for mild to moderate pain, should have been used when pain levels were below 8. The facility’s medication administration policy required medications to be administered safely, timely, and as prescribed.
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