Failure to Assess and Manage Pain During Improper Repositioning
Penalty
Summary
The facility failed to ensure a resident was properly assessed for pain during repositioning in bed. The resident had a diagnosis that included unspecified pain and a physician order for PRN Tylenol Arthritis Pain 650 mg every six hours as needed. A quarterly assessment documented moderately impaired cognition with a BIMS score of 11, and the care plan directed staff to monitor for skin changes and for pain and/or discomfort. The facility’s Pain-Clinical Protocol required staff and the physician to identify pain characteristics, including location, intensity, frequency, pattern, and severity, and to use a consistent, standardized pain assessment tool appropriate to the resident’s cognition level. After returning from the emergency room, the resident reported that a CNA and an LPN attempted to move them up in bed, during which the CNA leaned over and pushed down on the resident’s arm, causing pain. The resident stated they hollered and told staff their arm was hurting, but staff continued to move them up in bed. The LPN later acknowledged hearing the resident say, "Ow my arm," but did not assess for new pain, assuming it was the resident’s chronic shoulder pain, and did not determine the pain’s location or characteristics. The CNA described using an improper technique to move the resident up in bed by reaching across and pulling the draw sheet from one side, while the LPN lifted under the knees. Subsequent observations showed a bandage and dark purple bruising on the resident’s right forearm, and the DON reported being informed of bruising by the resident’s family member.
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