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Based on record review and interview, the Hospital failed to assess/monitor pain medication administration to one patient (Pt. #1) in a total sample of 10 in accordance with Hospital Policy.

The ED Activity Record, dated 7/6/13 at 4:47 P.M. indicated that Pt. #1 arrived at the Hospital ED (ED) complaining of right hip pain after a fall at the Nursing Home.

The Surveyor interviewed Family Member #1 by telephone on 10/18/13 at 9:55 A.M. Family Member #1 said that Pt. #1 was screaming in pain and a Family Member had made numerous attempts to have Pt. #1's pain assessed and pain medication to be administered.

The ED Activity Record, dated 7/6/13 at 5:31 P.M., indicated that Pt. #1 reported his/her pain to be a 10 on the numeric pain scale (0 is no pain and 10 the worst). The ED Activity Record indicated that Pt. #1's vital signs and pain were to be assessed every hour while in the ED.

The Electronic Medication Administration Record (eMAR), dated 7/6/13 at 5:44 P.M., indicated that Morphine (narcotic pain reliever) 2 milligrams (mg) intravenously (IV-into the vein) was ordered to be given to Pt. #1.

The eMAR indicated that Morphine 2 mg IV was administered to Pt. #1 at 6:52 P.M.

Pt. #1's reported 10 out of 10 hip pain was not addressed until 2 hours and 5 minutes after his/her arrival to the ED.

Based on record review and interview, the Hospital failed to ensure for one patient (Pt. #1) in a total sample of 10, that staff did not give the patient anything by mouth (NPO) as ordered by the Physician.
Findings include:

The Physician's Order Sheet, dated 7/10/13 at 9:15 A.M., indicated that Pt. #1 was ordered NPO (nothing to be taken by mouth).

The Surveyor interviewed Family Member #1 by telephone on 10/18/13, at 9:55 A.M. Family Member #1 alleged that, on 7/11/13, on the 7:00 A.M. to 3:00 P.M. shift, the nurse caring for Pt. #1, gave Pt #1 his/her medications mixed in applesauce and Pt. #1 was NPO due to aspiration risk (potential for solids or liquids entering the respiratory tract).

The Surveyor interviewed Nurse #3 on 10/22/13 at 11:53 A.M. Nurse #3 was Pt. #1's caregiver on 7/11/13, on the 7:00 A.M. to 3:00 P.M. shift. Nurse #3 said that she gave Pt. #1 his/her medications mixed in applesauce.

Based on record review and interview, the Hospital failed to assess/monitor pain medication administration to one patient (Pt. #1) in a total sample of 10 in accordance with Hospital Policy.

The Policy/Procedure titled, Pain Assessment and Management Protocol, effective 10/2000 and revised 2/2013, indicated that a patient will be assessed for pain after any intervention.

The ED Activity Record, dated 7/6/13 at 4:47 P.M. indicated that Pt. #1 arrived at the Hospital ED complaining of right hip pain after a fall at the Nursing Home.

The ED Activity Record, dated 7/6/13 at 5:31 P.M. indicated that Pt. #1 reported his/her pain to be a 10 on the numeric pain scale (0 is no pain and 10 the worst). The ED Activity Record indicated that Pt. #1's vital signs and pain were to be assessed every hour while in the ED.

The Surveyor interviewed Family Member #1 by telephone on 10/18/13 at 9:55 A.M. Family Member #1 said that Pt. #1 was screaming in pain and a Family Member had made numerous attempts to have Pt. #1's pain assessed and pain medication to be administered since his/her arrival to the ED.

The Electronic Medication Administration Record (eMAR), dated 7/6/13 at 5:44 P.M., indicated that Morphine (narcotic pain reliever) 2 milligrams (mg) intravenously (IV-into the vein) was ordered to be given to Pt. #1.

The eMAR indicated that Morphine 2 mg IV was administered to Pt. #1 at 6:52 P.M.

The ED Activity Record, dated 7/6/13 at 8:00 P.M., indicated that vital signs were taken but did not indicate a reassessment of pain.

An ED Nursing Note, dated 7/6/13 at 9:19 P.M., indicated that Pt. #1 continued to complain of pain (no numeric value documented) and Morphine 6mg IV had been administered to Pt. #1 at 8:35 P.M.