Impact of implementing the critical-care pain observation tool in the adult intensive care unit: A nonrandomised stepped-wedge trial

Majid A Alotni; Jenny Sim; Ginger Chu; Michelle Guilhermino; Daniel Barker; Stuart Szwec; Ritin Fernandez

doi:10.1016/j.aucc.2024.09.014

Impact of implementing the critical-care pain observation tool in the adult intensive care unit: A nonrandomised stepped-wedge trial

Aust Crit Care. 2024 Nov 2:101129. doi: 10.1016/j.aucc.2024.09.014. Online ahead of print.

Authors

Majid A Alotni¹, Jenny Sim², Ginger Chu³, Michelle Guilhermino⁴, Daniel Barker⁵, Stuart Szwec⁵, Ritin Fernandez³

Affiliations

¹ Department of Medical Surgical, Nursing College, Qassim University, Buraydah, Almleda 52571, Saudi Arabia; School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Australia. Electronic address: Majid.Alotni@qu.edu.sa.
² School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, Australia. Electronic address: https://twitter.com/@jennysim_1.
³ School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Australia.
⁴ School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Australia; Intensive Care Unit, John Hunter Hospital, New Lambton Heights, NSW, Australia.
⁵ Hunter Medical Research Institute, Data Science Division, New Lambton Heights, NSW, Australia.

PMID: 39489653
DOI: 10.1016/j.aucc.2024.09.014

Abstract

Background: Approximately 70% of patients in intensive care units (ICUs) experience untreated pain, often due to severe patient conditions and communication barriers.

Aim: The aim of this study was to implement the Critical-Care Pain Observation Tool (CPOT) to improve pain assessment in patients unable to self-report pain in the ICU.

Method: A stepped-wedge trial was conducted in six adult ICUs in Saudi Arabia between February and June 2022. The sequential transition of ICU clusters occurred in February 2022, from control to intervention, until all ICUs were exposed to the intervention. The primary outcome was the number of pain assessments, whereas the secondary outcomes were reassessments. Other outcomes were length of stay, mechanical ventilation duration, and administered doses of sedatives and analgesic agents. Statistical analyses were performed using the Statistical Analysis Software v9.4.

Results: A total of 725 patients unable to self-report pain were included; 65% (n = 469) were male with an average age of 55 years. Implementing CPOT showed a significant increase in the number of pain assessments (rate ratio: 1.77, 95% confidence interval: 1.45, 2.16, p < 0.001) and reassessments (rate ratio: 13.99, 95% confidence interval: 8.14, 24.02, p < 0.001) between intervention and control conditions. There was no significant effect on the ICU length of stay, mechanical ventilation duration, and the amount of sedation (midazolam, propofol, and ketamine) and analgesia (fentanyl) administered.

Conclusion: The study indicates that the implementation of the CPOT increased the frequency of pain assessment and reassessment. However, the impact on patient outcomes remains inconclusive. Further investigations focussing on CPOT as the primary pain scale are necessary to determine its holistic impact on patient outcomes over the long term.

Trial registration: NCT05488834.

Clinical trial registration number: This study was registered with the U.S. National Library of Medicine (ClinicalTrial.gov, NCT05488834).

Keywords: Adult; CPOT; ICU; Intensive care unit; Nurse; Pain; Stepped wedge.

Associated data

ClinicalTrials.gov/NCT05488834