title: Behavioral pain assessment tool for critically ill adults unable to self-report pain.
abstract: BACKGROUND
  Critically ill adults often cannot self-report pain.
  
  
  OBJECTIVE
  To determine the effect of the Critical-Care Pain Observation Tool on frequency of documentation of pain assessment and administration of analgesics and sedatives in critically ill patients unable to self-report pain.
  
  
  METHODS
  Data on patients in 2 intensive care units of a university-affiliated hospital were collected before and after implementation of the tool. Patients were prospectively screened for eligibility; data were extracted retrospectively.
  
  
  RESULTS
  Data were recorded for a maximum of 72 hours before and after implementation of the tool in the cardiovascular intensive care unit (130 patients before and 132 after) and in the medical/surgical/trauma unit (59 patients before and 52 after). Proportion of pain assessment intervals with pain assessment documented increased from 15% to 64% (P < .001) in the cardiovascular unit and from 22% to 80% (P < .001) in the other unit. Median total dose of opioid analgesics decreased from 5 mg to 4 mg in the cardiovascular unit (P = .02) and increased from 27 mg to 75 mg (P = .002) in the other unit. Median total dose of benzodiazepines decreased from 12 mg to 2 mg (P < .001) in the cardiovascular unit and remained unchanged in the other unit. Increased documentation of pain assessment was associated with increased age in the cardiovascular unit and with decreased maximum scores on the Sequential Organ Failure Assessment in the other unit.
  
  
  CONCLUSIONS
  Implementation of the tool increased frequency of pain assessment and appeared to influence administration of analgesics in both units.
authors: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. louise.rose@utoronto.ca
authors: Louise
authors: L
authors: Rose
authors: Lynn
authors: L
authors: Haslam
authors: Craig
authors: C
authors: Dale
authors: Leasa
authors: L
authors: Knechtel
authors: Michael
authors: M
authors: McGillion
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059408:Pain Management / Q000379:methods / Q000451:nursing*; D010147:Pain Measurement / Q000379:methods / Q000451:nursing*; D011446:Prospective Studies
chemical_list: D000700:Analgesics