Authors (including presenting author) :
Kwan KW(1), Chan KK(1), Wong SF(1), Leung SL(1), Wong CF(1), Yeung MW(1), Chiu MC(1), Li SC(1), Lee CH(1), Lo WP(1), Kwan YF(1), Chan CY(1), Shum HP(1)
Affiliation :
(1)Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Pain is a common and distressing presentation for patients requiring intensive care. Undoubtfully, an accurate and standardized pain intensity assessment is essential to provide pain control. Although the Verbal Description Scale (VDS) is regarded as the gold standard of pain assessment, nurses may not use it properly. Moreover, patients’ self-reports of pain mechanisms are often altered by the presence of endotracheal intubation, sedatives and altered level of consciousness. In PYNEH ICU, there was no objective tool to assess patients who were unable to verbalize pain. To provide better guidance for nurses, a validated and reliable pain assessment tool was introduced in March 2021.
Objectives :
1.To enhance nursing knowledge on using appropriate pain assessment tools
2.To introduce Critical Care Pain Observation Tool (CPOT) in ICU
3.To enhance patient pain assessment
Methodology :
Baseline information on nurses’ pain assessment patterns was retrieved from Clinical Information System (CIS) from 1 to 8 October 2019. CPOT was adopted as a behavioral pain assessment tool for unconscious, cognitively impaired and non-communicable patients. Structured training on standardized assessment tools was conducted in March 2021. The level of agreement of CPOT scores was evaluated within the first 6 months of implementation using Fleiss’ kappa coefficient. Staff performance on adopting appropriate assessment tools was reviewed by comparing CIS pain assessment data from 1 to 8 October 2021 with October 2019.
Result & Outcome :
A structured training on pain assessment tools was introduced as planned. Up to 97.8% of ICU nurses received the training. Nurses’ compliance with using VDS improved from 64.2% to 96.8%. A good agreement between the nurses’ judgement (κ=0.696, 95% CI, 0.690 – 0.702, p<0.0001) on CPOT scoring was reached. In the post-training phase, 100% pain assessment was achieved using appropriate tools, compared with 72% in the pre-training phase.
These results showed a significant improvement in nurses’ pain assessment practice. However, the short trial period and small sample size limited further analysis. The effectiveness of accurate pain assessment on patients’ pain control warrants further studies in subsequent phases.
