Assessing the Feasibility of the Use of the Critical-Care Pain Observation Tool Versus Non-Verbal Pain Scale in the Cardiovascular Intensive Care Unit and Surgical Intensive

Background: Accurate pain assessments in critically ill, mechanically ventilated patients can be difficult to obtain. The current pain assessment tool to assess pain in these patients at this medical facility is the Non-Verbal Pain Scale (NVPS). This pain scale uses vital sign variation as a component to assess pain. The Society of Critical Care Medicine no longer recommends the use of vital sign variation as a component to assessing pain due to it not being a reliable indicator. Methods: This QI project was implemented at a large academic medical facility in two intensive care units in the intermountain west region in Salt Lake City, Utah. By using a pretest-posttest study design, data was obtained about the use of NVPS before the implementation of the Critical Care Pain Observation Tool (CPOT) and after the implementation data was obtained regarding the use of CPOT. Nurses used both CPOT and NVPS hourly to calculate pain scores for mechanically ventilated patients.Results:The pre-implementation survey and post-implementation survey had 35 and 46 nurses respectively respond to the surveys via REDCap. A comparison of the surveys resulted with accuracy in CPOT pain assessments (p-value < .001), pain medication administration due to CPOT scoring (p-value < .001), and satisfaction of using CPOT (p-value .003). Nearly 60% of the nurses preferred CPOT as a pain assessment tool. There were 86 CPOT and NVPS pain assessment score forms collected. Pain assessment scores resulted with CPOT (13.4 + 15.4) and NVPS (8.3 + 9.7). There was statistically significant difference between CPOT and NVPS scores (5.1 + 10.4, p-value < .001). The calculated difference between CPOT scoring and NVPS scoring when compared to zero had a significant difference (5.6 + 11.4, p-value < .001). Conclusions: CPOT is found to be feasible to use to assess pain for patients who receive mechanical ventilation in the CVICU and SICU. CPOT had higher perceived accuracy, pain medication administration influence, and overall satisfaction when compared to NVPS. CPOT pain scores were overall higher than NVPS and can be indicative of underscoring a patient's actual pain level.