title: Development of a pain management algorithm for intensive care units.
abstract: OBJECTIVE
  To develop a pain management algorithm for intensive care unit (ICU) patients and to evaluate the psychometric properties of the translated tools used in the algorithm.
  
  
  BACKGROUND
  Many ICU patients experience pain. However, an evidence-based algorithm for pain management does not exist.
  
  
  METHODS
  Literature review, expert panel, and pilot testing were used to develop the algorithm. The tools were evaluated for inter-rater reliability between two nurses. Discriminant validity was evaluated by comparing pain during turning and rest.
  
  
  RESULTS
  An algorithm was developed. The Behavioral Pain Scale (BPS) and the Behavioral Pain Scale-Non Intubated (BPS-NI) discriminated between pain scores during turning and rest. Inter-rater reliability for the BPS varied from moderate (0.46) to very good (1.00). Inter-rater reliability for the BPS-NI varied from fair (0.21) to good (0.63).
  
  
  CONCLUSIONS
  The content of the pain management algorithm is consistent with the latest clinical practice guideline recommendations. It may be a useful tool to improve pain assessment and management in adult ICU patients.
authors.affiliation: Østfold Hospital Trust, Fredrikstad, Norway; Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway. Electronic address: Brita.Fosser.Olsen@so-hf.no.
authors.forename: Brita F
authors.initials: BF
authors.lastname: Olsen
authors.affiliation: Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Rustøen
authors.affiliation: Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: Østfold Hospital Trust, Fredrikstad, Norway; Faculty of Medicine, University of Oslo, Norway; Norwegian University of Life Sciences, Aas, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Jacobsen
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Berit T
authors.initials: BT
authors.lastname: Valeberg
mesh_terms: D000465:Algorithms; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000451:nursing; D015203:Reproducibility of Results
keywords: Acute pain; Critical care; Intensive care unit; Pain assessment; Pain management; Pain management algorithm