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VOLUME 23 , ISSUE 4 ( April, 2019 ) > List of Articles

ORIGINAL ARTICLE

Impact of Implementing the Critical Care Pain Observation Tool on Nurses’ Performance in Assessing and Managing Pain in the Critically Ill Patients

Mahnaz Modanloo, Afsaneh Mohsenpour, Hossein Rahmani, Shahram Moghaddam, Homeira Khoddam

Keywords : Analgesic administration, Critical care pain observation tool, Intensive care unit

Citation Information : Modanloo M, Mohsenpour A, Rahmani H, Moghaddam S, Khoddam H. Impact of Implementing the Critical Care Pain Observation Tool on Nurses’ Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian J Crit Care Med 2019; 23 (4):165-169.

DOI: 10.5005/jp-journals-10071-23146

License: CC BY-NC 4.0

Published Online: 00-04-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and aims: Pain management is one of the most important responsibilities of nurses in an intensive care unit (ICU). It is difficult to perform pain assessment appropriately in patients who are unable to report their pain. This study is aimed to determine the impact of implementing the critical care pain observation tool (CPOT) on the amount and frequency of analgesics’ administration in ICUs. Materials and methods: This interventional study was conducted in 2014. Sixty nurses and 240 patients were studied. This study was carried out in three phases: first the data about amount and frequency of analgesic administration were extracted from patients’ medical files. Then the CPOT was implemented into the nursing assessment process and finally, nurses’ performance regarding the amount and frequency of analgesic administration was recorded. This data obtained before and after intervention were analyzed using chi-square and independent t-test p values less than 0.05 were considered significant. Results: In this interventional study, we found that there was no difference in the demography and cause of ICU admission before and after implementation of CPOT (age p = 0.937, gender p = 0.996, and the cause of admission p = 0.996). We found that after implementing the CPOT into the nursing assessment process, the amount of analgesics administered (7.95 ± 8.77 mg vs. 11.01 ± 11.04 mg, p = 0.018) and the frequency of administration (2.91 ± 1.38 vs. 4.16 ± 0.99, p <0.001) increased significantly. Moreover, there was a significant increase in the frequency of pain assessment per patient per day in nursing practice after implementation of CPOT as compared to the practice before (7.2 ± 2.48 vs. 1.03 ± 1.63, p <0.001). The mean pain scores before and after the intervention (5.5 ± 1.08 vs.2.2 ± 0.48) were also significantly different. Conclusion: Applying CPOT, as an objective mean of pain assessment, was effective in improving the performance of ICU nurses in assessment and management of patients’ pain. It increased the amount and frequency of analgesic administration. We can recommend that COPT is a useful tool for assessment and management of pain in ICU patients and should be implemented in all ICUs.


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  1. Kaplow R, Hardin SR. Critical care nursing: synergy for optimal outcomes. Massachusetts: Jones & Bartlett Learning; 2007.
  2. Pronovost P, Goeschel C. Improving ICU care: it takes a team. Healthc Exec 2005;20(2):14–6, 18, 20 passim.
  3. Morton PG, Fontaine DK, et al. Critical care nursing: a holistic approach. Philadelphia: Lippincott Williams & Wilkins; 2005.
  4. Klein DG, Dumpe M, Katz E, et al. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung 2010;39(6):521–528.
  5. Topolovec-Vranic J, Canzian S, et al. Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. Am J Crit Care 2010;19(4):345–354; quiz 355.
  6. Vila H, Smith RA, et al. The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings? Anesth Analg 2005;101(2):474–480.
  7. Gélinas C, Fillion L, et al. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006;15(4):420–427.
  8. Gélinas C, Arbour C, et al. 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. Int J Nurs Stud 2011;48(12):1495–1504.
  9. Herr K, Coyne PJ, et al. Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations. Pain Manag Nurs 2006;7(2):44–52.
  10. Gélinas C, Fortier M, et al. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care 2004;13(2):126–136.
  11. Gélinas C, Harel F, et al. Sensitivity and specificity of the critical-care pain observation tool for the detection of pain in intubated adults after cardiac surgery. J Pain Symptom Manage 2009;37(1):58–67.
  12. Graham J. Adult patients’ perceptions of pain management at triage: a small exploratory study. Accid Emerg Nurs. 2002;10(2):78–86.
  13. Kwekkeboom KL, Herr K. Assessment of pain in the critically ill. Crit Care Nurs Clin North Am 2001;13(2):181–194.
  14. Mobily PR, Herr KA, et al. Validation of cutaneous stimulation interventions for pain management. Int J Nurs Stud 1994;31(6):533– 544.
  15. Arbour C, Gélinas C. Setting goals for pain management when using a behavioral scale: Example with the critical-care pain observation tool. Crit Care Nurse 2011;31(6):66–68.
  16. Lind L, Karlsson D, et al. Patients’ use of digital pens for pain assessment in advanced palliative home healthcare. Int J Med Inform 2008;77(2):129–136.
  17. Taylor A, Stanbury L. A review of postoperative pain management and the challenges. Current Anaesthesia & Critical Care 2009;20(4):188–194.
  18. Winkelman C, Norman D, et al. Pain measurement during labor: comparing the visual analog scale with dermatome assessment. Appl Nurs Res 2008;21(2):104–109.
  19. de Rond MEJ, de Wit R, et al. A pain monitoring program for nurses: effects on communication, assessment, and documentation of patients’ pain. J Pain Symptom Manage 2000;20(6):424–439.
  20. Sessler CN, Grap MJ, et al. Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care 2008;12(Suppl 3):S2.
  21. Sessler CN, Pedram S. Protocolized and target-based sedation and analgesia in the ICU. Crit Care Clin 2009 ;25(3):489–513, viii.
  22. Gallo A-M. The fifth vital sign: Implementation of the Neonatal Infant Pain Scale. J Obstet Gynecol Neonatal Nurs 2003;32(2):199–206.
  23. Hirsh AT, Jensen MP, et al. Evaluation of nurses’ self-insight into their pain assessment and treatment decisions. J Pain 2010;11(5):454–461.
  24. Safari M, Sedighi L, et al. The effectiveness of Behavioral Pain Scale in the assessment of pain in patients with low level of consciousness. JAP 2012;3(1):22–27. [In Persian].
  25. Williams TA, Martin S, et al. Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales. Am J Crit Care 2008;17(4):349–356.
  26. Rose L, Haslam L, et al. Behavioral pain assessment tool for critically ill adults unable to self-report pain. Am J Crit Care 2013;22(3):246–255.
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