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Based on record review, interview and review of facility policy, it was determined the facility failed to ensure the administration of pain medications was evaluated for effectiveness for three (3) of ten (10) sampled patients (Patients #1, #5 and #6). Record reviews revealed the three (3) patients were seen in the Emergency Department and pain medications were given. However, there was no documented evidence the nurse re-evaluated the patients for the presence of side effects or how effective the medications were in relieving the patients' pain, as directed by the facility's policy.

The findings include:

Review of the policy titled "Pain Management", undated, revealed patients were to be assessed for possible side effects of pain medications and for effectiveness of pain relief measures "to determine if current therapy is adequate". Continued review revealed the assessment was to be performed within thirty (30) minutes to one (1) hour after initiation of the pain therapy.

Review of the clinical record revealed Patient #1 was seen in the Emergency Department on 07/03/12 at 10:04 AM. Review of the Emergency Provider Record, signed by the Physician, revealed a diagnosis of Abdominal Pain related to the patient's post-surgery status. Review of the Physician Order Sheet revealed Dilaudid, one (1) milligram (mg) was ordered at 10:29 AM and again at 1:10 PM. (Dilaudid is a narcotic given for the management of pain.) Continued review revealed the nurse administered the ordered doses at 10:56 AM and 1:17 PM, respectively. Further review of nursing documentation revealed no pain assessment to evaluate the effectiveness of the medication was documented prior to the patient being discharged at 1:20 PM, only moments after the second dose was administered.

Clinical record review revealed Patient #5 presented to the Emergency Department on 10/12/12 at 2:00 PM with complaints which included Low Back Pain. Review of the initial nursing assessment revealed the patient reported pain rated seven (7) out of ten (10), with ten (10) being the most severe. Review of the Physician Order Sheet revealed an order for Toradol, thirty (30) mg. Review of nursing documentation revealed the medication was administered at 10:15 AM by the nurse. Continued review of the entire record revealed no documented evidence a follow-up pain assessment was conducted after the medication was administered prior to the patient's discharge from the facility at 11:06 AM.

Review of the clinical record revealed Patient #6 presented to the Emergency Department on 10/10/12 at 9:52 PM with a complaint of abdominal pain. Review of the nurse's initial assessment, at 10:37 PM, revealed the patient described the pain as "stabbing" in nature with a severity of eight (8) out of ten (10), ten (10) being the most severe. Review of the Physician Order Sheet revealed two (2) doses of Morphine, 2 mg. were ordered (Morphine is a narcotic pain medication). Continued review revealed the nurse administered the doses at 11:15 PM and 1:03 AM, respectively. Further review of the clinical record revealed no subsequent pain assessment for effectiveness of the interventions was documented.

Interview with the Emergency Department Unit Manager, on 10/12/12 at 2:00 PM, revealed she would expect to see a follow-up pain assessment within one (1) hour of administration of the pain medication.

Interview with the House Supervisor, on 10/12/12 at 3:05 PM, revealed nurses were to document an assessment of effectiveness of pain medication administration within thirty (30) minutes to one (1) hour of administration.

Interview with the Risk Manager and Safety Officer, on 10/12/12 at 4:00 PM, revealed all patients should be re-evaluated after the administration of pain medication.