Failure to implement updated pain management interventions for a resident with chronic pain. The resident, who had COPD, chronic viral hepatitis C, spinal stenosis, and OA, reported ongoing back, leg, and arm pain that was only partially relieved by medication. EMR review showed repeated complaints of wrist and arm pain, physician documentation that Neurontin would be increased, and discussion of a brace for the right hand, but the MAR and orders showed no corresponding changes. An LPN confirmed no recent pain med changes or brace order, and the DON stated the updates had not been caught in note review.
Failure to provide timely pain management for a resident with chronic pain, radiculopathy, heart disease, HTN, and anxiety. The resident reported long delays in call light response for PRN pain meds, often more than 2 hours at night, and said he received pain meds less often than usual, which left him unable to sleep and unable to attend therapy due to uncontrolled pain. Record review showed PRN pain meds were often given with scheduled med pass and pain assessments were sometimes completed up to 12 hours late.
Pain medication was not provided before wound care. A resident with venous insufficiency and chronic right leg and heel ulcers reported frequent pain and had a care plan that called for staff to anticipate pain relief. During wound care, an LPN cleansed and measured the wounds while the resident grimaced and stated that he had asked for acetaminophen earlier but it never arrived. The LPN did not check whether the resident had received acetaminophen or gabapentin before starting the treatment, and the medication was given later after the wound care was completed.
Failure to provide timely pain management: A resident admitted after hip fracture repair reported excruciating pain for about 48 hours after arrival, with staff saying oxycodone was back ordered and no alternative offered. The MAR showed blank entries for oxycodone on two days, no pain assessments or explanation for missed doses, and only one documented dose given the night before discharge.
A resident with a left femur fracture and left hip replacement did not receive timely pain medication as ordered, and pain documentation was incomplete during the overnight shift. The resident reported worsening leg pain, said medication had been delayed for hours, and law enforcement had to assist before the LPN gave Tylenol. Later, the resident had a pain score of 7 and was sent to the hospital after an x-ray showed the hip replacement was dislocated.
The facility failed to timely reorder and provide ordered pain medications for two residents with chronic pain, resulting in multiple missed doses of methadone and pregabalin (Lyrica). One resident with a history of opioid abuse and PTSD went three days without methadone, with MAR entries showing the drug as “on order” or “awaiting pharmacy delivery,” while the resident reported pain, irritability, sweating, and feeling they were going into withdrawal. Another resident with osteoarthritis and back pain missed several scheduled doses of Lyrica over multiple days, with MAR notes again indicating the medication was “on order.” The residents reported lying in pain and going days without medications, and staff interviews revealed delays related to obtaining new prescriptions and failures to utilize available backup medication.
A resident with intact cognition and an infected tooth had repeated reports of severe mouth/jaw pain, but ordered antibiotics were missed and the opioid pain medication was discontinued despite ongoing 10/10 pain. Dental services documented decayed teeth and recommended extraction plus antibiotics, yet the resident continued to report pain and there were no notes showing the MD was contacted about the excessive pain. The DON acknowledged the missed doses and uncertainty about why the pain medication was stopped.
Inadequate pain management for a resident with severe right hip pain was identified after he was observed grimacing, moaning, and rating his pain as 8/10 while trying to reposition for relief. The resident believed his oxycodone was scheduled rather than PRN, and staff reported he had declined therapy related to pain, could not reposition himself, and required extensive assistance with care due to ongoing pain.
A hospice resident with CREST Syndrome Scleroderma and Rheumatoid Arthritis, who was cognitively intact, reported waking in severe morning pain and stated they wanted to be awakened for nighttime pain medication. Review of the care plan and orders showed scheduled morphine every four hours plus PRN dosing for breakthrough pain, but the MAR documented multiple missed midnight doses, with nursing staff recording that the medication was not given because the resident was sleeping. The UM and DON confirmed the doses were not administered despite orders and policies requiring pain management consistent with the resident’s care plan and expressed preferences.
A resident with multiple chronic conditions and full cognitive abilities reported that pain medication was not available on arrival and that she waited over 24 hours for relief, with Tylenol ineffective and repeated requests for pain treatment. Records showed the first pain medication was not administered until about 28 hours after admission, despite prior facility records showing she had been receiving Tramadol before transfer, and the pain care plan only addressed observing and reporting pain rather than including pain treatment interventions.
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