Failure to provide timely pain management for a resident with a traumatic amputation and other chronic conditions. The resident reported severe left leg pain and stated she had only received Tylenol, while the ordered oxycodone/acetaminophen was not available in the cart or Omnicell. RN did not contact the physician for an alternate pain medication or provide pain interventions, and a scheduled Tylenol dose was also not given on time.
Lack of Parameters for PRN Pain Medications: The facility failed to ensure appropriate pain management for two residents because PRN pain medication orders, including opioids, had no specific parameters. One resident had chronic pain syndrome, fluctuating cognition, and bilateral BKA, while the other had multiple chronic conditions and intact cognition. MAR review showed opioids were given for pain scores as low as 2, 3, 4, and 5, and acetaminophen was given for a pain score of 8. The DON confirmed the orders lacked parameters and that the medications were administered outside the expected pain ranges.
Pain medication orders and administration were not managed accurately for two residents. One resident had duplicate tramadol orders, including a three-day order that continued to be used for months, while another resident missed scheduled Percocet doses when the medication was unavailable and instead received PRN Dilaudid. The DON confirmed the duplicate tramadol orders and that the short-term order was still being used, and staff confirmed the Percocet shortage and use of Dilaudid in its place.
Failure to provide adequate pain management for a resident with dementia-related diagnoses. The resident had an order for PRN Tylenol and was identified in the care plan as at risk for altered comfort, but MAR review showed reported pain levels without documentation of pain medication, other interventions, or a pain reassessment. An LPN stated she used the PAINAD scale, observed pacing and occasional facial grimacing, and could not verify that ordered analgesics or nonpharmacological measures were provided.
PRN pain meds were given to a cognitively intact resident with chronic pain and multiple comorbidities even when the documented pain level was zero or no pain assessment was recorded. The MAR/TAR review showed no documented non-pharmacological interventions such as repositioning, ice, distraction, or relaxation before PRN analgesics were administered, and staff confirmed PRN pain meds should not have been given for pain level zero.
A facility failed to complete required quarterly pain assessments for residents on narcotic pain meds and failed to administer scheduled narcotic pain doses as ordered for one resident. One resident with dementia had a missing quarterly pain assessment, another resident with an amputation stump and COPD missed three scheduled hydrocodone-acetaminophen doses when the med was not available, and a third resident with dementia and schizoaffective disorder had multiple missing quarterly pain assessments. The DON and RN confirmed the missed assessments and doses.
Failure to provide adequate pain management for a resident with chronic pain and multiple pain-related diagnoses. The resident returned from the hospital with persistent left shoulder pain rated 5/10, later reporting severe pain and guarding the shoulder, while the record showed scheduled diclofenac and gabapentin but no documented PRN pain medication administration despite notes stating PRN meds were given. The OT eval noted severe pain limited testing, the skilled note showed unchanged pain, and the DON verified the resident had no pain care plan and no PRN pain meds were ordered or administered during the period reviewed.
A resident with polyarthritis, left shoulder replacement, and chronic pain had physician orders and a care plan specifying multiple non-pharmacological pain interventions, including massage, positioning, ice therapy, relaxation, and diversional activities. Pain assessments showed frequent pain, with very few zero-pain readings, yet review of the MAR revealed that no non-pharmacological interventions were documented as provided throughout the stay. In interviews, a PA stated such interventions should be offered for pain, and an LPN, a unit manager, the DON, and the ADON all confirmed that these ordered non-pharmacological interventions were not implemented despite the resident’s repeated and almost constant pain complaints, contrary to the facility’s pain management policy.
A resident with multiple chronic conditions, cognitive impairment, and documented daily pain was admitted with orders for PRN Tylenol and every-shift pain assessments, along with a baseline care plan directing staff to monitor verbal and non-verbal pain signs and medicate per orders. Facility records showed that required pain assessments were repeatedly not completed on several shifts, and when pain scores of three and four were documented, there was no evidence that any pharmacologic or non-pharmacologic pain interventions were offered or provided. The resident’s family later reported the resident had been in pain and unwell, and increased pain complaints were eventually reported to an NP, but the Regional Nurse Consultant confirmed that pain relief was not offered at admission or when pain was documented, contrary to the facility’s pain assessment and management policy.
Failure to Provide Ordered Pain Management: The facility did not ensure ordered pain meds and comfort measures were provided for residents with chronic and acute pain. One resident missed a pregabalin taper dose and had severe neuropathic leg pain with crying, restlessness, and nausea; another had gabapentin and scheduled Norco omitted or delayed despite chronic pain and repeated missed doses; a third had fall-related hip/thigh pain, but ordered Tylenol ES and cold compresses were not documented as given.
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