Nurses' evaluations of the CPOT use at 12-month post-implementation in the intensive care unit.

BACKGROUND: Performing routine pain assessments with all intensive care unit (ICU) patients is strongly recommended in clinical practice guidelines. As many ICU patients are unable to self-report, the Critical-Care Pain Observation Tool (CPOT) is one of the two behavioural pain scales suggested for clinical use. Still, no study has described the evaluations of its use in ICU daily practice. OBJECTIVE: To describe the nurses' evaluation of the feasibility, clinical relevance and satisfaction with the CPOT use 12 months after its implementation in the ICU. METHOD: A descriptive design was used. It was conducted in the medical-surgical ICU of a university affiliated setting at Greenfield Park (Québec, Canada). A self-administered evaluation questionnaire including four sections (i.e. feasibility, clinical relevance, satisfaction and socio-demographic information) was completed by ICU nurses who were all trained to use the CPOT. The questionnaires were completed anonymously. RESULTS: A total of 38 ICU nurses returned their completed questionnaire (63% participation rate). Regarding its feasibility, the majority rated the CPOT as quick to use, simple to understand and easy to complete (92-100%). According to clinical relevance, close to 70% of ICU nurses acknowledged that the CPOT had influenced their practice, but lower results (<50%) were found for effective communication of pain assessment findings with the physicians and other health professionals. More than 80% of ICU nurses were satisfied with its daily use. CONCLUSION: The CPOT use was deemed feasible and relevant in daily practice as per the nurses' evaluations but did not allow an effective communication with other ICU care team members. RELEVANCE TO CLINICAL PRACTICE: Training should be offered to all members of the ICU care team, and other implementation strategies should be explored as well to ensure optimal uptake of a pain assessment approach which impacts on their decision-making process for pain management.

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.

BACKGROUND: The Critical-Care Pain Observation Tool (CPOT) is one of the few behavioural pain scales which have been developed and validated for the purpose of detecting pain in nonverbal critically ill adults. OBJECTIVES: This study aimed to complete a pre and post evaluation of the implementation of the CPOT on pain assessment/management nursing practices in the Intensive Care Unit (ICU) with nonverbal critically ill adults. DESIGN: A before-and-after study design was used. SETTING/PARTICIPANTS: The Intensive Care Unit (ICU) of a university affiliated health care centre in Montérégie (Canada) was selected for the implementation of the CPOT. All ICU nurses were trained to use the CPOT. Medical files were selected if the patient was 18 years or older, had been mechanically ventilated for a period ≥ 24hours, was unable to communicate, and had intact motor function. METHODS: This implementation study included three steps: 1) pre-implementation phase, 2) implementation phase, and 3) post-implementation phase. The pre-implementation phase included the review of 30 medical files to describe the current nursing practice in pain assessment and management prior to the introduction of the CPOT. During the implementation phase, 60 ICU nurses attended standardized training sessions on the use of the CPOT and practiced the scoring with the CPOT using patients' videotapes. In the post-implementation phase, the interrater reliability of ICU nurses when using the CPOT was tested using three patients' videotapes. Also, pain assessment and management nursing practices were evaluated by reviewing 30 medical files at 3 months, and 30 others at 12 months post-implementation. RESULTS: Nurses' percentage of agreement when scoring patients with the CPOT by viewing the videotapes was high post-implementation of the tool (>87%). Reports of pain assessments were more frequently charted in the medical files in the post-implementation phase (10.5 to 12 assessments in a 24-hour period) compared with the pre-implementation phase (3 assessments in a 24-hour period). Interestingly, fewer analgesic and sedative agents were administered during the post-implementation phase. CONCLUSIONS: The CPOT was successfully implemented and seemed to have positive effects on pain assessment and management nursing practices in the ICU. Further research is warranted to look at its impact on patient outcomes.