The Critical-Care Pain Observation Tool (CPOT) stands out as a significant behavioral pain scale meticulously designed and validated to accurately detect pain in nonverbal adult patients within critical care settings. Recognizing the paramount importance of effective pain management in the Intensive Care Unit (ICU), a study was conducted to evaluate the impact of CPOT implementation on nursing practices. This evaluation focused on pain assessment and management specifically for nonverbal critically ill adults.
This before-and-after study meticulously examined the integration of CPOT within the ICU of a university-affiliated healthcare center located in Montérégie, Canada. A comprehensive training program was administered to all ICU nurses to ensure proficient utilization of the CPOT. Patient medical files were carefully selected based on criteria including being 18 years or older, requiring mechanical ventilation for at least 24 hours, exhibiting inability to communicate, and possessing intact motor function.
The study unfolded in three distinct phases: pre-implementation, implementation, and post-implementation. Initially, the pre-implementation phase involved a thorough review of 30 medical files to establish a baseline understanding of existing pain assessment and management nursing practices before CPOT introduction. During the implementation phase, all 60 ICU nurses participated in standardized training sessions focused on mastering CPOT application and scoring techniques using patient video recordings. Subsequently, the post-implementation phase assessed the interrater reliability of CPOT scoring among ICU nurses through the analysis of three patient video recordings. Furthermore, nursing practices in pain assessment and management were evaluated by reviewing 30 medical files at the 3-month mark and another 30 files at the 12-month mark following CPOT implementation.
The results demonstrated a high level of agreement among nurses (>87%) in CPOT scoring when evaluating patient videos post-implementation, indicating successful tool adoption and understanding. Notably, pain assessment documentation in medical files significantly increased in the post-implementation phase, rising from an average of 3 assessments per 24-hour period to 10.5-12 assessments per 24-hour period. Interestingly, the study also revealed a decrease in the administration of analgesic and sedative agents following CPOT implementation.
In conclusion, the study confirmed the successful implementation of CPOT and its apparent positive influence on pain assessment and management nursing practices within the ICU. The CPOT serves as an effective organizational tool for critical care nursing, enhancing the systematic approach to pain management for nonverbal patients. Further research is recommended to comprehensively investigate the broader impact of CPOT on patient outcomes and refine its integration into critical care protocols.
