Pain Medications Administered Outside Ordered Parameters for PRN Use
Penalty
Summary
Surveyors identified a deficiency in medication administration in which a resident’s drug regimen was not kept free from unnecessary drugs, specifically pain medications given outside provider-ordered parameters. The cognitively intact resident had diagnoses including Type 2 Diabetes Mellitus without complications, a right heel pressure ulcer, and acute osteomyelitis of the right ankle and foot, and had a care plan addressing pain related to a right heel wound as well as risk for negative health outcomes related to continued substance use while in the facility. Provider orders included PRN Hydrocodone-Acetaminophen 5-325 mg every four hours as needed for pain intensity 4–10, to be held if the resident was drowsy, and PRN Acetaminophen 325 mg, two tablets every six hours as needed for pain intensity 1–3, not to exceed 3 grams in 24 hours. The facility’s Administration of Medications policy required staff to note the resident’s history and any parameters around drug administration and identified opioids as high-alert medications. Record review showed multiple instances in which nursing staff administered these medications outside the ordered pain-level parameters. The January Medication Administration Record (MAR) showed Hydrocodone-Acetaminophen was given once for a documented pain level of 1, and the February MAR showed it was given for pain levels of 0 and 1, despite the order specifying use only for pain levels 4–10. The January MAR also showed Acetaminophen was administered on several dates when the recorded pain levels were 6, 7, 5, 4, or 0, outside the ordered 1–3 pain range, and similar out-of-parameter administrations occurred in February for pain levels 4 and 5. Interviews with an LPN and the DON confirmed that medications are to be given according to provider orders, that these administrations occurred outside the ordered parameters, and that there was no documentation in the record authorizing administration outside the provider’s orders for the identified dates.
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