Failure to Use and Document Non-Pharmacological Interventions Before PRN Narcotics
Penalty
Summary
The facility failed to ensure non-pharmacological pain interventions were attempted, offered, and documented prior to administering PRN narcotic pain medication for one resident. The resident had diagnoses including a right femur fracture, hypotension, and low back pain, and her admission MDS indicated no cognitive impairment with occasional pain that interfered with daily activities, therapy, and sleep. Her care plan identified altered comfort related to the femur fracture and low back pain, with interventions such as positioning, rest, and massage. A provider order authorized oxycodone-acetaminophen 10-325 mg every six hours PRN for chronic pain, without specifying the pain location. The MAR for the month showed 17 administrations of oxycodone-acetaminophen and included a task to document non-pharmacological interventions each shift, such as ice, heated blankets, massage, repositioning, music, essential oils, food or drink, and relaxation breathing. However, documentation of non-pharmacological interventions was completed only once per shift rather than in relation to each PRN narcotic administration, and the entries showed the resident was offered food 20 times and repositioning once, with no other interventions recorded. Between admission and the survey review period, the record lacked comprehensive pain assessments that would identify pain location and characteristics. Nursing notes documented the date and time of PRN narcotic administration but did not indicate what, if any, non-pharmacological measures were attempted or offered beforehand, nor did they document the effectiveness of any such interventions when they were used. During interviews, the resident reported that ice and repositioning helped her leg pain and that staff would bring ice if she asked but did not offer it before giving a pain pill. Multiple nursing staff, the NP, and the DON all described an expected process that included assessing pain location and intensity, offering non-pharmacological measures first, and documenting interventions and effectiveness, and the DON confirmed that R3’s record did not show non-pharmacological interventions offered, attempted, or refused prior to PRN narcotic administration, despite the facility’s Pain Management Protocol requiring such comforting and complementary interventions.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.