HospitalInspections.org

Based on record review and interview the facility failed to ensure each patient's nursing care was evaluated for pain by accepted standards of nursing care for 1 (Patient #9) of 10 patients sampled. The record showed pain assessments were not done or not done in a timely manner to evaluate the response to the medication. Assessment of response to medication is a key factor in pain control.

The findings include:

Review of records on 6/5/12 revealed Patient #9 was admitted to the facility on 5/4/12 with swelling of the right leg which was identified as a fractured femur. The patient, during the course of the hospital stay had physician orders for oxycodone with acetaminophen and for morphine sulphate for pain control. Prior to receiving each dose of pain medication, the patient was assessed for pain which was documented in the Medication Administration Record (MAR).

On 6 occasions (5/6/12, 5/12/12, 5/19/12, 5/21/12, and 5/22/12 x2) there was no assessment for response to the pain medication given. On 7 occasions (5/6/12, 5/7/12, 5/8/12 x2, 5/18/12, 5/19/12, and 5/20/12) the pain assessment for response to the pain medication occurred more than 2 hours later.

The Nursing Drug Handbook (26th edition) notes the peak effect for oxycodone is 1 hour and peak effect for morphine is 20 minutes.

Facility policy #ORG-A.006 Assessment/Reassessment, reviewed 12/11, procedure #3 included, "Pain may be performed at specific/routine intervals related to: The patient's treatment and response to treatment ... Pain reassessment based on the patient's verbal or non-verbal perception of pain following treatment of pain ... "

Nursing Standard of Practice Protocol: Pain Management in Older Adults, by the Hartford Institute for Geriatric Nursing updated January 2008 contained nursing standards for controlling pain which included:
Follow-up Assessment:
1. Monitor treatment effects within 1 hour of [medication] administration and at least every 4 hours.
2. Evaluate patient for pain relief and side effects of treatment.
3. Document patient's response to treatment effects.

In interview at about 4:30 p.m. the Chief Nursing Officer acknowledged the lack of post-medication assessments for Patient #9.