Failure to Notify Hospice of Uncontrolled Pain Prior to Hospital Transfer
Penalty
Summary
The deficiency involves the facility’s failure to notify a hospice agency in a timely manner about a resident’s uncontrolled pain and escalating behavior. The resident was admitted on hospice services with multiple serious diagnoses, including metastatic prostate cancer to the bone, a stage 4 right heel pressure ulcer, osteomyelitis, cervical radiculopathy, chronic pain, peripheral neuropathy, and opioid dependence. The resident’s cognition was assessed as modified independent, and a Power of Attorney for Healthcare (POAHC) had been activated. Staff interviews and record review showed that the resident repeatedly reported pain at 9–10 out of 10, requested IV pain medication that the facility could not provide, and became verbally aggressive and impatient with call light response times. The Admissions Coordinator reported being informed that the resident had “maxed out” on pain medications and still had pain at 10 out of 10, and stated that hospice and family were notified that the resident’s pain remained uncontrolled and that the resident was requesting more pain medication than the facility could provide. However, the Hospice Director of Clinical Services stated hospice had not received any reports of uncontrolled pain or escalating verbally aggressive behavior prior to the morning when the Nursing Home Administrator and Admissions Coordinator informed hospice that the resident’s pain was 9–10 out of 10 and that the resident was being sent to the ER. The Hospice Director also stated the resident had not actually “maxed out” on pain medication and that medications could have been adjusted. The DON reported that the RN had given all pain medication the resident could have per facility understanding, found it ineffective, notified the on-call provider, and sent the resident to the ER, but could not recall if hospice was contacted before the transfer. The RN confirmed not notifying hospice prior to sending the resident to the hospital, stating the resident’s mind was made up about going to the hospital, and also verified not initially notifying the POAHC. The resident was sent to the ER and later died in the hospital.
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