Failure to Administer Ordered PRN Analgesic for Severe Pain
Penalty
Summary
The facility failed to provide appropriate pain management for a resident experiencing severe pain. Facility policy on administering pain medications states that pain management is based on a facility-wide commitment to resident comfort, defines pain management as alleviating pain to a level acceptable to the resident, and requires use of standardized pain assessment tools such as a 0–10 pain intensity scale. The policy, however, did not specify which numeric values corresponded to mild, moderate, or severe pain. In an interview, the DON (Employee E2) clarified that the facility’s pain scale categorized scores of 1–3 as mild pain, 4–6 as moderate pain, and 7–10 as severe pain. The resident, admitted with diagnoses including back pain, had a physician’s order for Morphine Sulfate 15 mg by mouth every 6 hours as needed for severe pain, and an order for pain assessment and monitoring every shift using a 0–10 pain scale with nonpharmacological interventions offered as indicated. Review of the medication administration record for January showed that during one 3–11 shift, the resident had a documented pain score of 7, which met the facility’s definition of severe pain. Despite this, the resident did not receive the ordered PRN Morphine Sulfate, and there was no documentation of any pain management interventions, pharmacological or nonpharmacological, being provided to alleviate the pain. In a subsequent interview, the DON confirmed that Morphine was not administered during that shift when the resident’s pain score was 7.
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