Does failure to manage residents’ pain and mismanagement of a resident’s medication potentially result in a facility filing false claims related to providing substandard quality of care in violation of the False Claims Act? [F600 Free from Abuse and Neglect, F697 Pain Management, F657 Care Plan Timing and Revision, F755 Pharmacy Services/Procedures/Pharmacist/Records, and F756 Drug Regimen Review]
Compliance Perspective – Quality of Care
Policies/Procedures: The Compliance and Ethics Officer, the DON and the Pharmacy Consultant will review policies and procedures regarding residents’ medication management and timely delivery of medications from the pharmacy.
Training: Staff will be trained on Abuse and Neglect, Pain Management, Care Plan Timing and Revision, and, with the Pharmacy Consultant, working with residents and their physicians to develop treatment plans and find alternate solutions. Staff will also be trained on the importance of requesting prescription refills on a timely basis to prevent any interruption in a resident’s treatment because of missed doses.
Audit: The Pharmacy Consultant will conduct a medication regimen review for all of the residents. Staff will survey residents and determine if their pain levels are being controlled with the medications they are receiving. Factors to consider include monitoring to determine if staff are overzealously responding to the CMS’ opioid drug reduction mandate, if staff lack empathy for residents’ pain and suffering, and/or if the facility is accepting residents with drug addictions when they cannot provide the proper care. The results of the audit and the medication reviews will be summarized and submitted to the QAPI/QAA Committee and the Compliance and Ethics Committee for recommendations.
After a health survey of the facility in May, a Washington nursing home was fined $117,000 for deficiencies related to the pain and medication management of five residents and poor medication management regarding residents with infections.
One of the residents told the surveyors that he “experienced pain almost constantly,” but the staff had reduced his opioid pain medication dosage. When the resident requested that his pain medication dose be increased, staff told him that taking the opioid medication with another medication he was receiving was dangerous. The surveyors reported that there was no indication that staff tried to work with the resident and his physician to develop a pain treatment plan or attempt to discuss or find alternate treatment solutions.
In several other instances, the facility “was not able to obtain timely refills for pain medications” and this resulted in residents’ missing dosages and experiencing pain. For one resident, the facility failed to provide medication promptly to treat an infection, “causing unnecessary pain, anxiety and harm.”
The Department of Social and Health Services along with a fine of $3,000 recommended that the Centers for Medicare & Medicaid Services (CMS) consider imposing a civil money penalty and terminate the nursing home’s certification if compliance was not achieved by November.
The nursing home agreed to make changes designed to improve residents’ pain treatments, including reviewing pain management plans with residents. The nursing home agreed to ensure that residents with infections were reviewed to ensure that medications being administered were appropriate for their diagnoses.
A follow-up visit in June indicated that the nursing home had corrected the earlier deficiencies.
