SAINT LOUIS, MO - A March 2025 inspection at Hillside Manor Healthcare and Rehab Center documented significant pain management failures affecting two residents, including a cancer patient who was transferred to the hospital after experiencing uncontrolled pain for two days.
Metastatic Cancer Patient Left Without Ordered Medications
The most serious violation involved Resident #18, a patient with metastatic breast cancer that had spread to the bones, causing severe pain concentrated in both lower legs. According to inspection records, facility staff failed to ensure the resident received pain medications as ordered by the physician.
The breakdown occurred on multiple levels. When the pharmacy failed to deliver the prescribed pain medications, staff did not notify the primary physician of the problem. Additionally, staff failed to inform the physician about medications that were available in the facility's emergency kit that could have provided relief.
The resident experienced uncontrolled pain and required hospital transfer just two days after admission to the facility.
Bone metastases from breast cancer represent one of the most painful conditions in oncology. When cancer spreads to bones, it can cause fractures, nerve compression, and inflammatory responses that produce intense, persistent pain. Effective pain management is considered essential for quality of life in these patients, and delays in treatment can lead to pain crisis situations requiring emergency intervention.
The standard of care for patients with known metastatic bone disease includes having pain management protocols in place before or immediately upon admission, with clear communication channels between nursing staff, pharmacy services, and physicians. When medications are unavailable, facilities are expected to contact prescribers promptly to arrange alternatives.
Systemic Communication Failures
The citation reveals a chain of communication breakdowns that compounded the problem. Staff awareness of the pharmacy delivery failure should have triggered immediate action, including physician notification and review of emergency medication supplies. The failure to communicate about available emergency kit medications suggests either inadequate staff training on emergency protocols or systemic gaps in medication management procedures.
For patients with serious pain conditions, even short delays in medication administration can have significant consequences. Pain that goes untreated for extended periods can lead to physiological stress responses, sleep deprivation, decreased mobility, and psychological distress. In cancer patients, uncontrolled pain can also accelerate disease progression through chronic stress mechanisms.
Wound Care Procedures Cause Documented Pain Episode
A second pain management failure involved Resident #14, who experienced significant pain during wound care procedures. Inspection records document that staff removed wound dressings that had adhered to wound sites on the resident's buttocks without adequate pain management.
The resident was observed crying during the procedure and requested that a Certified Nurse Aide spray over-the-counter Bactine onto the wound sites for relief.
When wound dressings adhere to tissue, removal can cause trauma to healing skin and expose nerve endings, resulting in acute pain. Standard wound care protocols call for pre-medicating patients before dressing changes when adhesion is anticipated, or using moisture to gently loosen adhered materials before removal.
The fact that the resident requested a topical anesthetic from a CNA, rather than receiving prescribed pain management from licensed nursing staff, indicates a gap in the facility's wound care pain protocols. Proper wound care should include assessment of pain levels, provision of appropriate analgesia before procedures, and documentation of pain management effectiveness.
Best Practices for Wound Dressing Removal
Medical guidelines recommend several approaches to minimize pain during dressing changes. These include using non-adherent dressing materials, applying saline or sterile water to soften adhered dressings before removal, administering prescribed pain medications 30-45 minutes before procedures, and having topical anesthetics available when ordered.
The use of over-the-counter products like Bactine, while providing some temporary relief, does not substitute for proper pharmaceutical pain management. Additionally, application of such products should be ordered by a physician and administered by appropriate clinical staff rather than requested by residents during painful procedures.
Additional Issues Identified
The inspection found that the pain management failures affected a sample population of 16 residents at the 145-bed facility. The citation was issued under F697, which addresses the federal requirement that facilities ensure residents receive treatment and care for pain in a manner consistent with professional standards.
Both cases demonstrate failures in the facility's systems for ensuring prescribed medications are available and administered, for communicating with physicians when problems arise, and for implementing appropriate pain management during care procedures.
Regulatory Standards for Pain Management
Federal regulations require nursing facilities to provide services that meet professional standards of quality. For pain management, this includes ensuring medications are available as ordered, monitoring pain levels regularly, and adjusting treatment approaches when current methods prove ineffective.
The Centers for Medicare and Medicaid Services considers pain management a fundamental component of resident care. Facilities are expected to assess pain upon admission, develop individualized pain management plans, and respond promptly when residents report uncontrolled pain.
The findings at Hillside Manor indicate that the facility's pain management systems require review and improvement to ensure residents receive timely and effective treatment for acute and chronic pain conditions.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Hillside Manor Healthcare and Rehab Center from 2025-03-20 including all violations, facility responses, and corrective action plans.
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