Pain Med Orders and Critical Care Pain Obsevation Tool (CPOT)

[rabitona]

Hi,

My hospital is adopting the Critical Care Pain Observation Tool (CPOT) to assess pain in non-verbal ICU patients. We like the tool, but are having difficulty in updating pain medication orders. Since the CPOT is a presence/absence scale, we can not accurately use the tool to determine severity (mild/moderate/severe pain) when multiple pain medications are ordered. That is, a CPOT score of 8 does not indicate more pain than a CPOT score of 3.

Therefore we cannot, for example, write:

1. X mcg of Med A for CPOT 3-4,

2. Y mcg of Med B for CPOT 5-6, and

3. Z mcg of Med C for CPOT 7-8.

Additionally, how are pain medications reordered, if at all, when a patient's condition changes (i.e. intubated/non-verbal -> extubated/verbal)?

I'm hoping some institution has figured out how to properly order pain medications because we have been spinning in circles trying to figure this out.

Any help would be appreciated!

[MunoRN, RN]

The CPOT based order I've seen are usually to keep giving sedation until the score is less than 2, for instance. Such as 25-50mcg fentanyl q 5 minutes, 0.5-1 mg ativan q 10 minutes for CPOT >1.

I don't find that standardized dosing based on really any scale's score to be all that useful, there are too many variables that come into play particularly variation in how different patients respond to different doses of meds.

Vent sedation meds are D/C'd on extubation and the need for pain control/anxiolytics are reevaluated. Some meds might be continued through the extubation process like precedex or fentanyl for pain if there is a source of discomfort besides the tube.

[calivianya, BSN, RN]

We actually recommend different amounts of pain meds for different CPOT scores, though most people just use their judgment about how much of a med to give.

[MunoRN, RN]

The interesting thing about CPOT is that it's accuracy was validated by comparing it to nursing judgement; they had nurses say whether or not a patient needed sedation and compared that to whether or not the patient had a positive CPOT score. So it's not really meant to drive nursing decisions, it's more of a way of capturing nursing judgement in a way that fits into the type of scoring system that an EMR can understand.