Pain medication, when properly ordered, administered and monitored for effectiveness, can provide patients with relief of their suffering and promote better patient outcomes. Unfortunately, we are observing some concerning practices regarding pain medication that are placing staff and patients at risk. Specifically, we are noting:
- Medication orders for duplicative therapeutic agents without defining the order of precedence for which medication should be given as the first line agent.
- Patients administered pain medication below the prescribed pain level when the patients requested a less potent agent without the medication order written in a manner that supports deferring to patient preference.
- Patients administered a less potent pain medication below a stated pain level in an attempt to lower the patients' pain. No orders were written for the stated pain level. Staff were not contacting the Provider to advise them of the increased pain and/or to seek analgesic orders.
- Patients administered pain medications per order but upon reassessment patients were documented to be in pain but without documentation that their pain goal was achieved or that additional analgesics were administered.
- No evidence that Pharmacy was reviewing orders for PRN pain medications to address gaps in therapeutic duplication
Organizations are encouraged to review their PRN pain medication orders to ensure that orders contain all required elements (Medication name, dose, route, frequency, reason/criteria for administration, along with any clarifying information for safe administration). Additionally, organizations should monitor the process where pharmacy reviews PRN pain medications and clarify any ambiguity or gaps in the order. This should include how these gaps are tracked, trended and addressed through the organization's Quality Assurance and Process Improvement program or as a component of their OPPE( Ongoing Professional Practice Evaluation) program. Finally, there should be monitoring conducted of PRN pain medication administration to determine that staff are administering to the order and properly evaluating the effectiveness of the analgesia.
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