Aligning Patient Pain Needs with Effective Medication Intervention

Following medical orders for pain medication is essential to support effective pain control.  If pain medications are not effective or ordered to address the patient’s complaint of pain, nursing staff must consult with the Provider team to adjust the plan of care to support the patient in achieving adequate pain control.  Unfortunately, our team has made a number of observations where nursing staff have not followed prescribed orders for the administration of pain medications:

  • A pediatric patient complaining of a moderate level of pain was administered medication prescribed for severe pain. The nursing staff felt that the patient’s pain level was more significant than what the patient indicated.  There was no documentation to support that assessment.  There was no consultation with the Provider team on these concerns.
  • A nurse medicated a patient for pain before discharge, although the patient was not complaining of pain. When asked by our team why the patient was provided pain medication, the nurse indicated that the patient would probably have pain during the ride home.  There was no medical order to support pre-medicating the patient.
  • An adult patient was complaining of severe pain over 24 hours. The nursing staff had been medicating the patient with medication ordered for moderate pain as that was the only analgesia ordered.  They had not contacted the Provider to inform them of the patient’s pain level.

Nursing staff must follow prescribed orders for the administration of pain medications.  Deviations from these orders, without modifications, can contribute to continued pain from under-medicating, overdosing the patients and potentially masking an underlying potential lethal condition.  In addition, the nurse is essentially operating outside of their scope of practice and may jeopardize their licensure.  It is imperative that medical orders that are not supportive of the patient’s plan of care goals (in this case, effective pain management) that the Provider team must be contacted with adjustments to the plan.

Leaders are encouraged to look for these deviations in pain medication administration practice.  Many organizations utilize pre-printed pain management order sets to guide the provider in prescribing comprehensive pain management to ensure timely and effective interventions.  Further discussion should occur to understand why staff do not contact the Provider in the aforementioned circumstances.

Please contact us for questions or more information at  704-573-4535 or

Courtemanche & Associates specializes in Healthcare Accreditation and Regulatory Compliance Consulting Services. With over 30 years of being in business and 100+ years of healthcare experience amongst our consulting team, we are ready to assist with your accreditation and regulatory compliance needs.

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