Failure to Administer Ordered Pain Medication and Notify Provider When Medication Unavailable
Penalty
Summary
The deficiency involves the facility’s failure to provide pain medication as ordered and to notify the provider when a resident’s ordered pain medication was unavailable. Resident #2, who was cognitively intact and dependent on staff for transfers, toileting, bathing, and dressing, had diagnoses including protein calorie malnutrition, contractures of both knees, chronic pain syndrome, generalized osteoarthritis, and open wounds to both lower legs. Physician orders included scheduled extended-release oxycodone (Oxycontin) twice daily, scheduled immediate-release oxycodone (Roxicodone) every four hours for chronic pain, and PRN oxycodone for breakthrough pain, along with an order to monitor and document pain levels and use non-pharmacological interventions before PRN medication. The resident’s pain care plan identified him as at risk for pain or discomfort due to wounds and disease processes, with interventions to administer medications as ordered. Record review showed that multiple doses of the resident’s scheduled Roxicodone were not administered. On one day in January, four of six scheduled doses were not given, and another scheduled dose was not given on a later date, with the MAR indicating “other/see nurses notes” for several missed doses. Nursing progress notes documented that Roxicodone was on order and that nurses were unable to access the pyxis, and that there was none of the medication on hand despite reports that it had been reordered. One note also documented that the resident refused an offer to get up for an hour daily because he had no pain medication. For the missed dose on the later January date, there was no documentation in the nursing progress notes explaining why the medication was not administered. Interviews further described the circumstances around the missed pain medication. Resident #2 reported that he had missed his pain medication three or four times since admission, that missing his immediate-release oxycodone led to increased leg pain and withdrawal-like symptoms, and that staff told him the facility was waiting for the medication from the pharmacy when it was unavailable. An LPN stated she reordered medications when the card reached a certain level and relied on providers being present on weekdays, and she was unsure of the process on weekends or overnight. The DON and regional clinical resource stated that if a medication was unavailable, they expected nurses to notify the provider to consider a substitute or hold the medication and document the communication, and later acknowledged they were unsure why a dose was not administered on the later January date and that there was sufficient stock at that time. Staff interviews also confirmed that the resident frequently complained of pain and relied on timely administration of his pain medications, while the facility did not document provider notification when the ordered pain medication was unavailable.
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