Pain assessment tool for sedated/ intubated patients?

[alenor]

We are doing a project about using a standardized pain tool for our non-verbal patients. I would like to know what other hospitals are currently using. What pain assessment tool do you use for your sedated/vented/non-verbal patients? Do your physicians include this tool as basis for the pain medications in their orders? Please include your unit and the hospital you work in, only if you want to. Thank you!

[Sun0408, ASN, RN]

We don't have a standard pain scale for these types of pts. Common sense goes a long way. I work trauma surgical ICU so it is obvious these pts will need pain management at frequent intervals during there recovery. We use our judgement, VS, HR, resp rate and depth as well as any facial expression, splinting, or agitation. If the pt is sedated we use the BIS monitoring system to measure the amount of sedation, it also has a EMG reading, some say when that red line increases it is an indication of pain so we will also treat with an increasing EMG line.

Our physicians are great at ordering pain medications.

[JoyfulRN14, BSN, RN]

We use CPOT: Critical Care Pain Observation Tool.

It looks at facial expression, body movements, compliance with ventilator (if intubated), and muscle tension. 0-2 points for each category with a result out of 8.

It basically puts into words the things you intuitively look for to assess pain - if your patient is tense and grimacing and fighting the vent, you don't need a scale to tell you it is likely pain. But this way we have a scale to chart it, since "pain is the fifth vital sign" and yada yada yada.

We have a great analgesia/sedation protocol to manage pain and sedation, and it is geared toward CPOT to measure pain and MAAS to measure level of sedation.

I work in a med/surg ICU.

[BelgianRN]

Our facility (university hospital - Belgium) uses the BPS (Behavioural Pain Scale) for this purpose and naturally as Sun0408 has said common sense. I included an article about BPS (BPS).

Our normal sedation strategy always includes a continuous sedative (propofol or midazolam) and a continuous opioid (remifentanil or sufentanil) for pain management. Second line sedation usually involves continuous ketamine. We might add paracetamol IV q 6 hours based on the likelihood of weaning/extubation and body temperature.

We register pain scale at least q 8 hours in our PDMS (it is an automated order upon admission). It is also registered whenever we validate an order for any pain killer.

It works via a pop-up menu that consists of a page with all the body zones that you can check/uncheck to indicate where the pain is located, or we check "generalized pain". There is also a box that indicates the rational for giving pain meds: either the zones above, prevention, added sedation, shivering, and "others". You can also indicate you didn't give any meds just did the assessment and will follow-up.

Then there is the VAS or the normal painscores you can indicate for verbal patients and there is a section that holds the BPS. One of these three needs to be filled out before the system allows you to close the window and continue working with the PDMS.

[thompd01]

I work in the ICU. We do not have a specific pain scale for nonverbal patient's. We use the 0 to 10 pain scale. With zero being no pain and ten being the worst pain you have ever experienced. The scale has facial expressions that go along with the numbers.

However, I have done some research on pain scales for nonverbal patients and thought it might be something to start at our hospital. After research I felt it to be a complicated process to get essential the same results as we previously have. The pain scale that kept coming up in research was the Behavioral Pain Scale as talked about above.

[JWOkStRN]

I work in a Neuro ICU and fortunately my nurse manager, who was a nurse educator for our hospital developed a Non-Communicative Adult pain scale called the NCOT. It uses standard baselines, movements, agitation and ventilator tolerance, and physiologic changes in pt comfort levels that can be seen, to document and treat pain. I'm not sure how widely it's used, but you might do a search for NCOT and see what you can find. I know that it is a great tool for us and treating our vented/sedated pts and nonverbal Neuro pts. Hope that helps a little.

[mamatara]

I work in a Cardiac ICU and Stepdown unit in NC (14 beds ICU, 14 beds stepdown). We use the CPOT and PAINAD pain scales. CPOT is for our intubated/sedated patients and PAINAD is for those with cognitive impairment (usually patients with dementia). Most of our pain med orders are either by ranges of mild, moderate, severe or in case of sedation protocol by RASS sedation score.