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Based on record review and interviews, the Hospital failed to ensure that one out of ten (Patient #1) applicable patients was assessed for pain according to Hospital Policies and Procedures and failed to ensure that the prescribed treatment for constipation was administered and evaluated.

Findings include:

The Hospital Emergency Center (EC) Record, dated 3/14/13 at 5:33 P.M., indicated that
Patient #1 (Pt. #1) was brought to the Hospital after a motor vehicle accident. The EC record indicated that Pt. #1 was admitted to the Hospital for multiple fractured ribs, a small pneumothorax (collapse of lung) and a concussion (contusion to brain).

Hospital Policy 01-085, " Management of Pain ", effective 1/2001 and revised 1/2011, indicated that any patient who is receiving pain management intervention(s) must have pain reassessed by the nurse every 4 hours while awake or more frequently if necessary. After any pain management intervention, pain scores must be assessed at an appropriate interval appropriate for the given intervention and re-assessment by the nurse must be documented on the appropriate pain management flow-sheet.

The Physician Order Sheet, dated 3/16/13 at 8:14 A.M., indicated that the patient controlled Morphine infusion (a method whereby the patient can self-administer a pain medication at pre-determined times and amounts) was to be discontinued and Oxycodone 5 milligrams (mg) by mouth every 4 hours as needed for pain was ordered.

The Daily Focus Assessment Report, dated 3/16/13 at 8:54 A.M., indicated that Pt. #1 reported his/her pain to be 8 out of 10 (numerical pain scale where 0 is no pain and 10 is the worst).

The Daily Focus Assessment Report, dated 3/16/13 at 9:48 A.M., indicated that the patient controlled Morphine infusion was discontinued.

The Medication Administration History Report, dated 3/16/13 at 9:35 A.M., indicated that Pt. #1 was administered Oxycodone 5mg by mouth.

The Daily Focus Assessment Report did not indicate a pain assessment was completed after the 9:35 A.M dose of oxycodone.

The Medication Administration History Report, dated 3/16/13 1:44 P.M., indicated that Pt. #1 was administered Oxycodone 5mg by mouth.

The Daily Focus Assessment Report did not indicate a pain assessment was completed after the 1:44 P.M dose of oxycodone.

The Physician Order Sheet, dated 3/16/13 at 3:45 P.M., indicated that an additional one time dose of Oxycodone 5mg by mouth was ordered.

The Medication Administration History Report dated 3/16/13 indicated that Pt. #1 was given the additional dose of Oxycodone 5mg by mouth at 4:09 P.M.

2) Documentation review indicated that Patient #1 was receiving narcotics for pain for the duration of his/her admission. The Physician Desk Reference (PDR) indicated that constipation is a frequent side effect of narcotic administration.

The Daily Focus Assessment Report, dated 3/15/13 and 3/16/13, indicated that Pt. #1 had positive bowel sounds and was passing flatus but no bowel movement was documented.

The Daily Focus Assessment Report, 3/17/13 at 4:56 P.M., indicated that Pt. #1's abdomen was distended with positive bowel sounds and passing flatus.

The Daily Focus Assessment Report, dated 3/18/13 at 12:16 A.M. indicated that Pt. #1 reported that he/she was constipated.

The Daily Focus Assessment Report, dated 3/19/13 at 10:14 A.M., indicated that Pt. #1 reported that he/she had not had a bowel movement since admission.

The Daily Focus Assessment Report, dated 3/19/13 at 10:53 A.M., indicated that Pt. #1 had positive bowel sounds and was passing flatus but no bowel movement was documented.

The Physician Order Sheet, dated 3/19/13 at 2:30 P.M., indicated that a Fleet enema was ordered for Pt. #1.

The Daily Focus Assessment Report, dated 3/19/13 at 6:17 P.M., indicated that Pt. #1 reported that he/she was constipated.

The Daily Focus Assessment Report, dated 3/20/13 at 1:31 A.M. and 9:47 A.M., indicated that Pt. #1 had positive bowel sounds and was passing flatus but no bowel movement was documented.

The Daily Focus Assessment Reports for 3/19/13 and 3/20/13 did not indicate that Pt. #1 was administered a Fleet enema or that he/she had a bowel movement.

The Patient Care Plan Report, initiated on 3/15/13 at 2:51 A.M. to 3/1913 at 11:47 A.M., did not indicate that constipation was identified as a potential problem secondary to narcotic administration.

Pt. #1 was discharged home on 3/20/13 at 3:47 P.M.without evidence of receiving the ordered enema or of having a bowel movement for six days.