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Based on observation, interview and record review it was determined the facility failed to ensure pain medication was administered in accordance with the practitioner's orders and within accepted standards of practice, for one (1) of ten (10) sampled patients (Patient #1). The facility failed to ensure Patient #1 received PRN (as needed) pain medication in a timely manner upon request.

The findings include:

Review of the Administrative Policy titled "Standards of Care for Pain Management", revised August 2006, revealed the hospital is "committed to the delivery of attentive analgesic care".

Review of the Pharmacy policy titled "Drug Delivery", revised May 2006, revealed the drug delivery process includes delivery by pharmacy personnel, pneumatic tube system, or pickup by nursing personnel.

Review of the Pharmacy policy titled "Refills and Missing Doses", revised March 2008, revealed refills and missing doses were ordered from the nursing unit using the Replace Dose function in the computer. Continued review revealed labels are printed in the Pharmacy, the appropriate medication is prepared, and the pharmacist reviews the accuracy of the medication prior to dispensing. The policy did not include a time frame for dispensing of the medication after the request was made.

Review of the clinical record revealed the facility admitted Patient #1, on 02/03/12, with diagnoses which included Cellulitis of the right lower extremity. Review of the Admission Nursing Assessment, dated 02/03/12, revealed Patient #1 reported pain to the right leg, and rated the intensity as seven (7) on a scale of one (1) to ten (10), with ten (10) being the highest.

Review of the admission medication orders, dated 02/03/12, revealed Patient #1 was to receive Ibuprofen, 600 milligrams (mg), every six (6) hours as needed for pain.

During the initial facility tour, on 02/22/12 at 9:25 AM, Patient #1 was observed sitting up in the chair at the bedside. Patient #1 reported it took several hours, at times, to receive medication for leg pain. He/she stated Motrin (brand name for Ibuprofen) was ordered but was not always available on the unit. He/she further stated it took a long time for the nurses to get the drug from the pharmacy. Continued interview revealed on 02/21/12, Patient #1 requested Motrin at about 9:00 AM, but did not receive it until 2:30 PM.

Interview with Registered Nurse (RN) #1, on 02/22/12 at 1:45 PM, revealed Motrin was not stocked on the unit. She stated if a medication was not available, the nurse completed the "Request Dose" form and Pharmacy personnel would deliver the medication on their next round, or the nurse could go pick the medicine up at the Pharmacy. On further interview, RN #1 reported it could take up to an hour to get a replacement dose.

Interview with Pharmacist #1, on 02/22/12 at 3:30 PM, revealed Motrin was not stocked on the units. She stated a twenty-four (24) hour supply of PRN medications was sent up on admission. She explained subsequent doses were sent only on request by the nurse. She further stated Pharmacy personnel made deliveries on the top of every hour and could tube the Motrin to the unit if needed. On continued interview, Pharmacist #1 stated the nurse could call the Pharmacy to request the needed medication be tubed up right away.

Interview with RN #2, on 02/23/12 at 9:10 AM, revealed sometimes it was hard to get medications from Pharmacy in a timely manner. She stated it took up to thirty (30) minutes on night shift, and longer (time not specified) on day shift. She further stated she would call the Pharmacy if a replacement dose was not received within thirty (30) minutes. During the interview, RN #2 stated, "I know who you are talking about", and called Patient #1 by name. She stated she had suggested to Patient #1 that nursing could request the physician order the Motrin as a scheduled drug, so it would be in the patient's drawer without the nurse having to fill out special requests. She stated she asked Patient #1 about scheduling the medication, and Patient #1 declined.

Interview with the Pharmacy Manager, on 02/23/12 at 4:10 PM, revealed he had investigated the delay but was unable to determine what happened. He stated the request came through, then was immediately cancelled. He stated he had been looking at other requests for a similar problem. He stated the longest he could imagine a refill should take would be one (1) hour.

Interview with the Clinical Pharmacy Coordinator, on 02/23/12 at 4:10 PM, revealed he felt there was a miscommunication between the Pharmacy and the Nursing Department. He stated a monthly meeting between the two (2) departments had been initiated on 02/23/12 when the problem was brought to their attention.