Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study

Behavioral Pain Assessment Tool for Critically Ill Adults Unable to Self-Report Pain

“…The rate was also a marked improvement from compliance at baseline. A similar compliance rate for documented pain assessment was reported by Topolovec-Vranic et al, 13 whereas Gélinas et al 14 reported a median of 12 documented assessments (every 2 hours) per 24 hours of ICU stay 12 months after CPOT implementation, although compliance cannot be calculated because institutional recommendations for frequency of documentation were not described.…”

“…For example, Payen et al 27 found that only half of the patients treated with opioids on day 2 of the patients' ICU stay had documented assessments of pain. Other studies 13,14 on implementation of behavioral pain assessment tools had low baseline rates of documented pain assessment. In a recent multicenter 1-day point prevalence study 13 of 10 routine care processes involving 50 ICUs and more than 650 patients, variability was detected in compliance in all care practices, but documentation of pain scores was one of the practices with the lowest compliance (35%; IQR, 17%-62%).…”

“…However, in other studies, implementation of a behavioral pain tool had the opposite effect on opioid administration. Gélinas et al 14 detected a reduction in opioid administration and postulated that this effect was due to improved guidance in pain management decisions and ability to discriminate pain from other symptoms as well as a reduction in the number of trauma patients after implementation. Similarly, decreased use of opiates and better pain control were achieved in a large before-and-after study 29 in which protocols for management of analgesia, sedation, and delirium were implemented that included targeting of analgesia to pain scores.…”

“…In a small study 13 involving patients in a neurotrauma ICU, introduction of the Nonverbal Pain Scale 9 increased documentation of pain assessments and decreased recalled severity of the pain patients experienced. More recently, Gélinas et al 14 reported increased pain documentation and decreased administration of analgesic and sedative agents after introduction of the Critical-Care Pain Observation Tool (CPOT) in a small mixed ICU population (30 patients before, 30 at 3 months, and 30 at 12 months after implementation). However, few studies have evaluated the effect of these tools on pain assessment and management practices; most published studies 7,8,14 have been conducted by investigators involved in the development and or validation of the tools.…”

Observational Pain Scales in Critically Ill Adults

“…Interestingly, implementation of the CPOT was associated with decreased frequency of administration of sedatives and analgesics. Gélinas et al 40 provide 2 possible explanations: increased ability of nursing staff to discern pain from other symptoms (such as anxiety) or decreased number of trauma patients in the group after implementation because of a change in the center's trauma designation.…”