Failure to Administer Scheduled Morphine for Hospice Resident’s Nighttime Pain
Penalty
Summary
Surveyors identified a failure to provide ordered pain management when nursing staff did not administer scheduled morphine doses to a hospice resident as prescribed. The resident, admitted with CREST Syndrome Scleroderma and Rheumatoid Arthritis and assessed as cognitively intact, reported waking up in severe pain in the mornings and believed they were not receiving their nighttime pain medication. The resident stated they wanted to be awakened for nighttime medication, even if asleep, so that their pain would not become severe. The resident’s care plan under hospice services included administering medications as ordered, observing for effectiveness, evaluating for signs and symptoms of pain, and providing care based on the resident’s end-of-life comfort preferences. Record review showed physician orders for morphine 100 mg/5 ml, 2 ml every four hours, and an additional PRN order for 2 ml every two hours for breakthrough pain. The MAR for March documented that seven scheduled midnight doses of morphine were not administered on multiple dates, with RN documentation indicating the medication was withheld because the resident was sleeping. The Unit Manager confirmed, based on the electronic record and narcotic sign-out sheets, that these doses were not given and stated the medication should have been administered unless the resident requested not to be awakened. The DON also stated that medications should be given as ordered. Facility policies on Pain Management and Hospice required that pain management be provided consistent with professional standards, the care plan, and resident goals and preferences, including directives for managing pain and uncomfortable symptoms.
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