30 Developing the Paediatric Intensive Care Pain Assessment Tool (PICPAT): A Team Effort!

Abstract

Aims: A variety of pain assessment scores exist in PICU; however none are used universally, and many also assess sedation. Our aim was to develop an exclusive pain assessment score applicable to all ages of PICU patients, both ventilated and non-ventilated. Methods: Audit of current practice within a 20 bed, multidisciplinary PICU. This was followed by a literature search, and then a series of focus groups with staff. Following this a pain tool was developed via a modified Delphi approach. Results: The audit revealed (a) that documented pain assessment was often lacking within the clinical notes, and (b) pain scores, when assessed via our current scoring system rarely correlated with analgesics given. The literature search revealed 10 potential candidate scores; all of which were rejected at the focus groups. Reasons included: length of time required to perform, operational definitions being too subjective, and some definitions were not applicable to our patient group (e.g. age specific, non-ventilated). From this, we amalgamated aspects of several scores via the Delphi approach, producing a 4-domain score (Paediatric Intensive Care Pain Assessment Tool: PICPAT) comprising an ordinal scale of 0-8. Conclusions: The next stage will involve training a core clinical group of nurses for assessment of the scores construct and concurrent validities, and inter-rater agreement.