HospitalInspections.org

Based on policy and procedure review, medical record reviews, and staff interviews, Emergency Department (ED) staff failed to reassess pain according to policy for 3 of 5 ED patients reviewed (#19, #17, #18)

The findings included:
Review of hospital policy titled "ASSESSMENT-REASSESSMENT OF THE EMERGENCY DEPARTMENT PATIENT", dated 09/2018, revealed "....Pain will be reassessed after intervention...." Review did not reveal a guide for the timing of reassessment.

Review of Lippincott Procedures presented as the hospital's policy, dated 11/15/2019, revealed "...For the ED....reassessment will be performed after an intervention and will include, at a minimum, the intensity of the pain. ..."

1. Review of an ED medical record revealed Patient #19 arrived to the ED on 01/29/2020 at 0955. Review revealed a pain score of 3 at triage. At 1143, review revealed Patient #19 received Dicyclamine (for stomach/ intestinal cramping), Toradol (used to treat pain), and Zofran (for nausea). Review revealed pain was not reassessed until discharge at 1508 (3 hours, 25 minutes later).

Interview with the ED Nurse Manager (NM), on 02/13/2020 at 1505 revealed the NM would expect reassessment to be done one to one and a half hours after an intervention. Review revealed the ED staff was better at completing discharge pain assessments than those after an intervention.

2. Review of an ED medical record revealed Patient # 17 arrived to the ED on 09/17/2019 at 0045 with a chief complaint of nausea, vomiting and abdominal pain. Record review revealed the patient was given Morphine 4 milligrams IV (intravenous medication for pain) at 0352. Review did not reveal that pain was reassessed after the intervention. Review revealed Patient # 17 received Hydrocodone (for pain) at 0545 and revealed the patient was discharged at 0552 (2 hours after a pain intervention). Review failed to reveal another pain reassessment after triage.

Interview with the ED NM, on 02/13/2020 at 1505 revealed the NM would expect reassessment to be done one to one and a half hours after an intervention. Review revealed the ED staff was better at completing discharge pain assessments than those after an intervention.

3. Review of an ED medical record revealed Patient #18 arrived to the ED on 09/16/2019 at 2048. Review revealed a triage pain assessment of 7 with a chief complaint of nausea, vomiting, and diarrhea. Review revealed the patient was given Bentyl (helps reduce symptoms of stomach/intestinal cramping) and Zofran (for nausea) at 2333. Review revealed Patient #18 left the hospital against medical advice (AMA) on 09/17/2019 at 0156 (2 hours 23 minutes after an intervention and 5 hours, 8 minutes after arrival).

Telephone interview with MD #5 (Medical Doctor) on 02/12/2020 at 1010 revealed Bentyl was given for spasming / cramping.

Interview with RN #6 (Registered Nurse) on 02/12/2020 at 0940 revealed the RN did not recall if she saw the patient after giving the medications. Interview revealed patients should have been reassessed after Bentyl and Zofran were given. Interview revealed a reminder "pops up" for Zofran but not for Bentyl. Interview revealed later Patient #18 came out of the room, stated the doctor was not doing anything for him, he was still in pain, and he was leaving.

Interview with the ED NM, on 02/13/2020 at 1505 revealed the NM would have expected some reassessment on Patient #18.

NC00156500, NC00154929, NC0159179