Failure to Provide Timely PRN Pain Management for Resident With Severe Pain
Penalty
Summary
The deficiency involves the facility’s failure to provide timely, ordered pain management to a resident with severe, frequent pain and significantly impaired cognition. The resident had diagnoses including a left lower leg bone fracture, stroke, and constipation, and the MDS showed he experienced frequent, severe pain that frequently affected sleep and almost constantly affected day-to-day activities. The EHR contained a physician’s order for an opioid every four hours as needed, and the care plan directed staff to administer pain medications per order if non-medication interventions were ineffective and to evaluate the resident’s pain. Progress notes showed the last pain medication was given shortly after midnight, and later that afternoon the resident was repeatedly heard and observed requesting pain medication and a laxative. From mid-afternoon onward, the resident called out for pain medication and, during multiple interactions with CNAs, clearly requested pain medication and something for constipation. Staff D and Staff E acknowledged his requests and stated they had informed the nurse, but the CMA was observed engaging in non-clinical activities such as serving popcorn and moving the popcorn machine before returning to the medication cart and going down another hall. During this time, the resident continued to report severe pain, rating it 9.5/10, and repeatedly stated he needed a pain pill and a laxative. He was transferred to his wheelchair and taken to the dining room, still without receiving pain medication, and only after this, when the CMA approached him at the table, was his pain medication finally administered and documented. The DON later stated staff should have consulted the nurse to immediately assess the resident’s pain and administer the ordered pain medication, and the facility’s pain policy required implementation of the medication regimen as ordered and ongoing assessment and documentation of pain and interventions.
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