The effects of the Critical-Care Pain Observation Tool on pain assessment/management nursing practices in an intensive care unit with brain-injured critically ill patients

Abstract

Accurate pain assessment and management in critically ill patients withcognitive alterations who are unable to communicate constitute a major challenge for themedical and nursing staff of Intensive Care Units (ICUs). This study want assess the impact of Critical Care Pain Observation Tool (CCPOT) scale in ICU practice and evaluate the effects on pain assessment and management in brain-injured critically ill adult patients. This before-and-after study was carried out in an Italian ICU, where data were collected before (T0) and after (T1) implementation of the CCPOT in brain-injured critically ill adults. The study population consisted of 81 patients (35 before and 46 after intervention). The use of propofol fell significantly and at the same time the use of morphine increase significantly (morphine: t(80) = 1.51, p =.02) after intervention.Analysis of the data with respect to pain relief and prevention during some nursing care activities revealed a significant increase in the use of fentanyl citrate and paracetamol. Pain management was in line with the protocol, which envisaged administration of pain medications to patients with CCPOT scores less than 3 in 76.8% of cases. The present findings strongly support the value of the CCPOT scale in managing ICU patient pain in conjunction with medical and nursing staff training. However, further studies of larger patient samples should be performed.