Failure to Assess and Report Escalating Pain and Bruising
Penalty
Summary
Failure to assess and control a resident’s pain occurred when staff did not adequately evaluate or report escalating pain and new bruising for a resident with multiple complex medical conditions, including dementia, spinal stenosis, osteoarthritis, hip fracture, seizure disorder, and other chronic diagnoses. The resident’s care plan identified dementia with behavioral disturbances, ADL self-care deficits, incontinence, elopement risk, agitation, anxiety, restlessness, aggression, resistance to care, convulsions, restless leg syndrome, hip fracture, and seizure disorder. Facility investigation notes document that on multiple occasions staff and another resident heard or observed the resident yelling or hollering in pain. CNAs reported that the resident was in a lot of pain and had bruising on the left chest, and one CNA reported this to an LPN. Another LPN stated that on two consecutive days the resident was spitting out food, stopped feeding himself, had a low-grade temperature, a left leg contracture, and increased pain, but did not notify anyone of these changes. The Medication Administration Record shows that the resident began receiving pain medication regularly and had repeatedly high pain scores ranging from five to nine out of ten over several days, yet there was no documented physician notification of this increased pain prior to a later date. One LPN acknowledged being told about bruising and significant pain but did not assess the bruises, only gave pain medication, and did not notify anyone. Another LPN noted bruising but stated being unaware that it needed to be reported. The Director of Nursing later stated that bruising was first noticed several days before any notification was made and that the medical doctor should be notified of a change in pain, acknowledging that waiting several days for notification was a delay in care. The facility’s Pain Management Program policy required notifying the physician of a change in condition and assessing and reassessing pain control measures for effectiveness, but the record and interviews show that these steps were not followed for this resident.
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