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Base on interview and record review the facility failed to ensure patients were monitored to determine whether the pain medication administered was therapeutically beneficial in seven (7) of twelve (12) patient records reviewed (Patients # 3,4,8,9,11,13,15).

Finding include:

Patient #3
" Record review of the medication record of patient #3, admitted 11/29/2017 for tongue cancer. On 12/8/2017, it was revealed the patient received Tylenol 650 mg (milligram) by mouth (PO) at 854 for pain. No pain reassessment was documented.

Patient # 4
" Record review of the medication record of patient #4, admitted 11/28/2017 for sepsis. On 12/8/2017 it was revealed the patient received Morphine 2 mg (milligram) intravenously (IV) at 854 for pain. No pain reassessment was documented.
Patient #8
" Record review of the medication record of patient #8, admitted 12/3/2017 for oral abscess. On 12/8/2017, it was revealed the patient received Norco 5 mg (milligram) PO at 857 for pain. No pain reassessment was documented.

Patient #9
" Record review of the medication record of patient #9 admitted 12/3/2017 for cellulitis left leg. On 12/8/2017, it was revealed the patient received Norco 7.5 mg (milligram) PO at 952 for pain. No pain reassessment was documented.

Patient #11
" Record review of the medication record of patient #11 admitted 12/7/2017 for abdominal pain. On 12/8/2017, it was revealed the patient received Norco 1 tablet PO at 941 for pain. No pain reassessment was documented.

Patient #13
" Record review of the medication record of patient #13 admitted 12/2/2017 for hematoma. On 12/8/2017, it was revealed the patient received Dilaudid 1 mg IV at 916 for pain. No pain reassessment was documented.

Patient #15
" Record review of the medication record of patient #15 admitted 11/28/2017 for sepsis. On 12/8/2017, it was revealed the patient received Morphine 2 mg IV at 916 for pain. No pain reassessment was documented.

In an interview with the nurse manager (staff #54) 12/8/2017 at 1120 she stated, pain reassessment should be completed one hour after administration of intravenous injection and 2-3 hours for oral medications.

Record review of the facility policy "TMH Pain Management" dated 2/29/2016 stated under Procedure and A. Assessment and reassessment of pain: 2. Reassesses pain after any pharmacological intervention within one hour based on patient condition, type/effect of medication and route of administration (see Appendix C)
Appendix C: Peak Effect of Analgesic Medications
Tylenol PO Peak effect: 1 hour
Morphine IV Peak effect: 5-10 minutes
Dilaudid IV Peak effect: 10-20 minutes