Failure to Follow Physician-Ordered Pain Management Regimen
Penalty
Summary
The deficiency involves the facility’s failure to provide comprehensive pain management and to administer pain medication according to physician orders for one resident with significant pain-related conditions. The resident was admitted with diagnoses including polyneuropathy and gout and had a care plan noting acute/chronic pain related to chronic physical disability and a stage 4 pressure wound to the sacrum. Physician orders included acetaminophen 325 mg, two tablets by mouth every four hours as needed for mild pain, and hydrocodone/acetaminophen 5-325 mg, one tablet via G-tube every six hours as needed for pain levels 5–10. Staff used the PAINAD scale to assess this non-verbal resident’s pain, observing increased respirations and heart rate, open eyes and mouth, and facial grimacing when the resident was in pain. However, the nurse reported using nursing judgment to decide which pain medication to give and expressed reluctance to administer hydrocodone/acetaminophen due to concern that the resident’s body would get used to it. Record review of the Medication Administration Record for the month showed that when the resident had documented pain levels of 8, 5, 6, and 7, staff administered only acetaminophen, despite the physician’s order specifying hydrocodone/acetaminophen for pain levels 5–10. Conversely, hydrocodone/acetaminophen was given when the resident’s documented pain levels were 4 and 0, when acetaminophen should have been used according to the orders. The DON confirmed that the resident sometimes received acetaminophen when pain was above 5 and hydrocodone/acetaminophen when pain was lower, contrary to the physician’s orders and the care plan intervention to administer hydrocodone/acetaminophen as ordered. This failure to follow the prescribed pain management regimen and the facility’s medication administration policy resulted in the resident’s pain not being effectively managed and not being treated per physician orders.
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