Failure to Provide Premedication for Pain Before Wound Care and Bed Bath
Penalty
Summary
The deficiency involves the facility’s failure to provide timely and appropriate pain management before performing wound care and a bed bath for a resident with a Stage 4 pressure ulcer. The resident was originally admitted with diagnoses including muscle weakness and a displaced subtrochanteric fracture of the left femur and had moderately impaired cognitive skills, requiring significant assistance with activities of daily living. The physician’s orders included a pain management consult and hydrocodone-acetaminophen 5-325 mg every six hours as needed for severe pain rated 7–10. During an observed wound care session, the treatment nurse asked the resident for a pain rating, and the resident reported a pain level of 7. As certified nursing assistants repositioned the resident and removed a pillow from under the heels, the resident moaned and verbalized pain in the groin and back, stating, "You're doing everything else to hurt me." Despite this, the treatment nurse proceeded with wound care without administering pain medication or allowing time for any pain medication to take effect. Later in the same session, while wound care was ongoing, the treatment nurse again asked the resident for a pain rating, and the resident continued to report a pain level of 7. The nurse asked if the resident wanted them to stop and return after pain medication, but the resident responded, "Let's get this done," and the procedure continued without premedication. After wound care, a bed bath was provided by certified nursing staff, during which the resident cried out in pain three times. By the end of the observation period, the resident stated having experienced 45 minutes of pain. Interviews with the treatment nurse and the DON confirmed that pain management prior to treatment is considered important to promote comfort and prevent suffering, and the facility’s pain management policy states that the facility will identify circumstances when pain can be anticipated and implement pharmacologic and/or non-pharmacologic interventions to manage or prevent pain, which did not occur in this instance.
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