Failure to Treat Resident Requesting PRN Pain Medication With Respect and Dignity
Penalty
Summary
The deficiency involves staff failure to treat a resident with respect and dignity when the resident attempted to request PRN pain medication. Certified Nursing Assistant (CNA) 2 reported witnessing a registered nurse (RN 5) not acknowledging Resident E, who is cognitively intact, has chronic pain syndrome, uses opioid pain medication, and communicates via a tablet due to aphonia. Resident E came to the nurse’s station with her communication tablet to speak with RN 5 about pain medication that was due, but RN 5 did not look up or acknowledge her. Resident E then began pounding her cane on the desk and kicking it to get attention. When CNA 2 informed RN 5 that the resident needed her attention, RN 5 responded, “I know, thanks captain obvious, I know how to do my job,” and continued to work without acknowledging the resident, later speaking to her without looking up. CNA 3 corroborated this sequence, stating that Resident E was very upset after being taken back to her room. Earlier that morning, CNA 3 had answered Resident E’s call light when the resident requested PRN pain medication around 6:00 a.m. CNA 3 relayed the request to RN 5, who stated the resident had received pain medication at 2:30 a.m. and was not due again until 8:30 a.m. When CNA 3 informed Resident E of this, the resident stated it was incorrect and that she had last received pain medication around midnight, which made her very upset because she knows when her PRN medications are due. In an interview, Resident E reported that a nurse gave her PRN pain medication at 11:00 p.m. and refused to give her PRN oxycodone at 5:00 a.m., and that she did not receive her medication until 8:00 a.m. She stated that RN 5 frequently withholds and prolongs giving her PRN pain medications, causing her to wait up to two hours and resulting in increased pain. LPN 8 indicated that during training with RN 5, they observed RN 5 specifically make Resident E wait hours for PRN pain medication without knowing why. The resident’s care plans included interventions to support communication and pain management, such as allowing a calm, unhurried environment, listening carefully, validating expressions, and using non-pharmacological pain interventions, and the facility’s Resident Rights policy affirmed the right to be treated with respect and dignity.
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