Failure to Provide Timely Post-Surgical Pain Management
Penalty
Summary
The deficiency involves the facility’s failure to provide timely and adequate pain management for a newly admitted resident following cervical spinal fusion surgery. The resident’s admission MDS documented intact cognition, a diagnosis of cervical spinal stenosis, and the need for post-surgical aftercare. The baseline care plan identified pain/comfort issues with a goal of adequate pain relief, including both non-pharmacological interventions and PRN pain medications such as acetaminophen and oxycodone. Provider orders directed staff to monitor pain every shift and to use non-pharmacological interventions, documenting those used. Despite these orders, the January MAR showed no administration of acetaminophen and first documented oxycodone administration more than a day after admission, even though the resident reported severe pain. Documentation inconsistencies were also present, including an incorrect pain rating entry and missing MAR entries for doses noted in progress notes. On the day of admission, the TAR showed the resident’s pain rated as 7/10 during one shift, yet the only non-pharmacological intervention documented was food and drink, and there was no documentation of pain assessments in the progress notes for that day. Subsequent pain assessment logs and progress notes indicated pain ratings of 7/10 and higher, with family members reporting that the resident’s stated pain level understated the true severity. Family interviews described the resident as having constant, severe pain, not wanting to move or eat, and having used the call light for pain medication without receiving it in a timely manner. Staff interviews confirmed that the resident’s ordered oxycodone was not available at the facility upon admission due to a miscommunication about the prescription, and that the resident did not receive narcotic pain medication until the following day. Nursing staff and the NP reported that oxycodone should have been available through the facility’s medication bank and that residents should not have to wait for pain medications when in significant pain. The LPN described the usual admission process of faxing orders to the pharmacy and confirming receipt, and stated she did not know why this resident waited so long for pain medication. An RN acknowledged that with a pain rating of 7/10, she would not rely on non-pharmacological interventions first and stated the resident should have received pain relief on the day of admission. The DON acknowledged a disruption in the process for obtaining pain medications timely for this resident and noted ongoing gaps in nurses following the established process. The facility’s pain management protocol required timely identification and assessment of pain, care planning for pain management, and provider notification with alternative interventions if prescribed medications were not available or delayed, which did not occur as required in this case.
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