Failure to Provide Timely Pharmacologic and Non-Pharmacologic Pain Management
Penalty
Summary
The deficiency involves the facility’s failure to provide timely pain management interventions for a resident admitted with significant back and leg pain and diagnoses including lumbar spinal stenosis with neurogenic claudication, acute cystitis without hematuria, anxiety, and depression. The resident was discharged from the hospital to the facility with an order for oxycodone 5 mg by mouth every eight hours as needed for pain for up to three days, and physician orders at the facility directed staff to assess pain and discomfort every shift and administer oxycodone 5 mg PO every eight hours as needed. The resident’s care plan identified risk for pain due to lumbago with sciatica and neuropathy, with interventions to administer analgesics as ordered, offer non-pharmacological pain interventions, and notify the physician if interventions were unsuccessful or if the pain complaint represented a significant change. Pain assessments documented pain levels ranging from two to six over several days, yet the Medication Administration Record showed that oxycodone was not administered from the date of admission through several subsequent days. The DON confirmed that the oxycodone prescription was not faxed to the pharmacy upon admission, so the medication was not received in the regular delivery, and that this omission was not identified until several days later. During this period, the resident’s daughter frequently reported to the DON, in person and by phone, that the resident was in pain. The DON stated that once the missing prescription was discovered, nursing staff were instructed to obtain the medication from the contingency box, where oxycodone was available, but an LPN did not contact the pharmacy for authorization to remove the narcotic from the contingency supply, and the medication was not accessed. The DON also reported that when the resident requested an ice pack to help ease pain, nursing staff told the resident there were no ice packs available, despite multiple ice packs being present at each nurses’ station. The DON verified that from admission through several days afterward, the resident did not receive ordered pain medication or non-pharmacological interventions such as cold compresses, contrary to the facility’s pain management policy, which required provision of pain management services and allowed for non-pharmacological measures including cold compresses.
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