Failure to Follow PRN Pain Orders and Arrange Timely Pain Management Consult
Penalty
Summary
The facility failed to provide appropriate pain management for a resident with chronic pain conditions, including bilateral hip osteoarthritis with artificial hip joints and fibromyalgia. The physician had ordered pain to be monitored using a 0–10 scale, Dilaudid 8 mg PO every three hours as needed for moderate to severe pain rated 4–10, and Morphine ER 15 mg PO twice daily for pain management. The resident’s care plan identified acute pain with interventions to give medications as ordered and monitor pain levels. However, review of the Medication Administration Record showed that Dilaudid, which was ordered only for pain levels of 4–10, was administered on multiple occasions when the documented pain level was 0/10, indicating no pain at the time of administration. The ADON confirmed that licensed staff should evaluate pain before administering PRN pain medication and that the resident should not receive PRN pain medication when pain is 0/10. The facility also failed to ensure timely follow-through on a physician’s order for a pain management consultation due to uncontrolled pain. The order for a pain consult was written in late October 2025, but the resident had not yet been seen by a pain management specialist at the time of the survey. Progress notes showed repeated attempts to contact the pain clinic, with staff reaching only voicemail on several occasions and no documented successful scheduling of an appointment. During interview, the resident reported generalized pain, difficulty moving, and stated she was supposed to receive Dilaudid every three hours but felt it was not being given as ordered, and that her request to see a pain doctor had not yet been fulfilled. The ADON acknowledged that the pain management consult ordered months earlier had not resulted in an appointment and that the resident’s pain management needed to be re-evaluated.
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