Failure to Provide Timely and Effective Pain Management for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate pain management for a resident with multiple medical issues, including acute kidney failure, kidney stones, urinary tract infection, and primary osteoarthritis of the left hip. The resident had moderate cognitive impairment and reported pain in multiple areas, including his hip, arms, legs, and teeth. Physician orders initially included PRN acetaminophen 325 mg every four hours for pain, which was later discontinued, and then PRN oxycodone 2.5 mg every eight hours for pain. Documentation showed that on one date the resident received acetaminophen for a pain level of six, which was not effective, followed by another dose that was effective. An orthopedic note documented the resident’s left hip pain and the plan for further interventions, including urology and dental evaluations. On another date, the resident’s pain escalated significantly. At approximately midday, the resident was documented as yelling out with pain rated 9/10. At that time, narcotics were noted as “not due,” and Tylenol was administered while the NP was notified. Shortly thereafter, the NP ordered an increase in oxycodone to 5 mg every eight hours PRN, and a dose was administered. The MAR and controlled drug record indicated that the oxycodone dose was effective at a later assessment, with the resident resting; however, an observation later that same afternoon found the resident in bed yelling out that he was in pain. The ADON later stated she did not hear the resident if he hollered out after the oxycodone administration. Family interviews revealed additional concerns about pain management on an earlier date. A family member reported that the resident was screaming in pain and that staff told her Tylenol would not be available for another 40 minutes. The family member stated she had to locate staff to assist the resident and provide pain medication, and that the LPN on duty said the NP would not be in until the next day and would not address the resident’s pain, and that the nurse would not call the physician. The LPN later confirmed she was aware of the family’s concerns, gave Tylenol, did not recall if the resident was hollering in pain, and did not call the NP because the NP preferred to see residents in person for narcotic pain medications, instead leaving a message in the log book for the physician. These actions and inactions occurred despite facility policies requiring notification of the physician and representative upon changes in condition and administration of pain medications in accordance with professional standards of practice.
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