586 Patient Satisfaction for the Use of DVPRS in the Assessment of Pain in the Burn and Surgical ICU

Abstract

Abstract Introduction The assessment and treatment of pain has become increasingly important in light of the opioid epidemic. Inadequately managed pain can lead to increased risk of psychiatric illness. The numeric rating scale (NRS) is used in most ICUs and only assesses pain intensity. Although it is reliable, valid, and user-friendly, other publications have criticized this one-dimensional pain assessment tools as offering little information about the impact of the pain on the patient’s life. The defense and veterans pain rating scale (DVPRS) is a multi-dimensional tool designed to assess the patient’s pain intensity as well as how the pain interferes with the patient’s general activity, sleep, mood and stress. Studies have shown that it has good validity and reliability in the inpatient and outpatient military population with neuropathic and non-neuropathic pain. The DVPRS has not been evaluated in critical care patients. Thus, this study comparatively investigated ICU patients’ satisfaction with the DVPRS versus the NRS. Methods This was a prospective pilot study performed from September 2018 to July 2019 in a 10 bed burn intensive care unit (BICU) and 10 bed surgical intensive care unit (SICU) at a university teaching hospital. This was an IRB approved study. All enrolled patients were older than 18 years of age and were CAM-ICU negative. The participating staff members were educated on the use of the scales prior to the start of the study. Routine treatment of pain was not altered by the study. Pain was assessed by staff nurses randomly assigned to use the NRS or DVPRS tool. The selected tool was used on admission, during wound care and every 4 hours or upon patient need. The patients completed satisfaction surveys on the day of discharge. Results 42 patients participated and 32 completed the study. 18 patients were in the DVPRS arm and 14 were in the NRS arm. Our primary outcome was patient satisfaction, ranked on a scale from 0–10, where 0 was the lowest score and 10 was the highest. Overall, patients in the DVPRS cohort had higher median satisfaction scores (median score: 10, interquartile range: 8–10) than the NRS cohort (median score: 8, interquartile range 7–9), though this difference did not reach statistical significance (p=0.16). However, DVPRS patients were significantly more likely to be “completely satisfied” than NRS patients (55.6% in DVPRS patients versus 21.4% in NRS patients; p=0.04). Furthermore, upon multivariate logistic analysis adjusting for age, gender, and ICU using the NRS pain scale conferred lower odds of complete satisfaction with pain management (odds ratio: 0.19, p=0.04). Conclusions Our study showed that ICU patients preferred the DVPRS over the NRS. The DVPRS appeared to be as effective as the NRS in pain relief and gave providers more information about patients’ pain.