The Critical-Care Pain Observation Tool (CPOT) is a validated behavioral pain scale designed to assess pain in non-verbal, critically ill adults. This article examines the implementation of CPOT in a university-affiliated Intensive Care Unit (ICU) and its impact on nursing practices related to pain assessment and management.
The study employed a before-and-after design, focusing on the ICU of a healthcare center in Canada. All ICU nurses received comprehensive training on utilizing the CPOT. Patient inclusion criteria included: age 18 or older, mechanically ventilated for at least 24 hours, inability to communicate, and intact motor function.
The implementation process consisted of three phases: pre-implementation, implementation, and post-implementation. The pre-implementation phase involved reviewing 30 medical files to establish baseline pain assessment and management practices. During the implementation phase, 60 ICU nurses participated in standardized training sessions, utilizing patient videotapes to practice CPOT scoring. The post-implementation phase comprised inter-rater reliability testing using videotapes and evaluation of pain assessment/management practices through medical file review at 3 and 12 months post-implementation.
Post-implementation, inter-rater reliability among nurses using CPOT was high, exceeding 87% agreement. A significant increase in documented pain assessments was observed, rising from an average of 3 assessments per 24-hour period pre-implementation to 10.5-12 assessments post-implementation.
Furthermore, a notable decrease in the administration of analgesic and sedative agents was observed following CPOT implementation. This suggests that more accurate pain assessment facilitated more targeted and effective pain management strategies, potentially reducing the need for continuous or excessive medication. The reduction in sedative use may also contribute to improved patient outcomes by minimizing the duration of mechanical ventilation and delirium.
This study demonstrates the successful implementation of the CPOT in an ICU setting. The tool led to improvements in pain assessment and management practices, including increased frequency of assessments and a reduction in analgesic and sedative use. While the findings are promising, further research is needed to investigate the direct impact of CPOT implementation on patient outcomes, such as pain levels, length of stay, and overall quality of life. Future studies could explore the long-term effects of CPOT use and its integration with other pain management protocols in critical care settings.
