Failure to Timely Assess and Manage Severe Pain for Resident With Hip Fracture
Penalty
Summary
The deficiency involves the facility’s failure to comprehensively assess and timely manage severe pain for a resident with a left hip/femur fracture. The resident, who had intact cognition and required extensive assistance with mobility and personal care, had PRN orders for Tylenol 650 mg every six hours and Methocarbamol 500 mg twice daily for pain and muscle spasms. The care plan identified the resident as being at risk for pain related to osteoarthritis, with interventions to administer medications as ordered and evaluate their effectiveness. On the evening in question, CNAs observed the resident’s left leg to be abnormally positioned, with the hip protruding and the resident yelling out in pain during incontinence care and repositioning. They immediately notified an LPN, who assessed the resident and noted the leg was rotated, with yellow-tinged bruising at the left hip, and the resident reporting pain in the left groin area. The physician was notified and an x-ray was ordered. Record review showed no evidence that a comprehensive pain assessment, including a pain rating and description of pain quality, was completed at the time the severe pain was identified. The x-ray later suggested a left hip fracture, and the resident was subsequently ordered to be sent to the hospital. The MAR indicated that only one dose of Methocarbamol was administered that day at 9:00 p.m., despite the resident having been yelling out in pain at approximately 6:30 p.m., and there was no documentation that Tylenol was given between the onset of pain and the resident’s transfer to the hospital. The self-reported incident and facility investigation initially indicated that pain medication had been administered, but review of the MAR confirmed that PRN pain medications were not given in a timely manner after the resident’s complaints of severe pain, and that documentation of pain assessment and pharmacologic intervention did not align with facility pain management policy.
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