Degree Conferred Date

1-18-2019

Degree Name

Doctor of Nursing Practice

Document Type

Culminating Project Paper

Degree Type

Doctoral

Department

School of Nursing

Project Advisor

Anne Stoltz

Faculty Committee Member

Alonya Elgrably; Patricia Lead; Krishnamurthy Umapathy

Abstract

Background: Pain assessment in critically ill patients using an evidence-based and reliable tool is crucial in providing pain management and promoting recovery of the patients in the Intensive Care Units (ICU). Inadequate pain management can have short-term and long-term complications. Critical Care Pain Observation Tool (CPOT) has been rigorously tested and has been recommended as a valid and reliable pain assessment tool by the Society of Critical Care Medicine and the American Association of Critical Care Medicine.
Objective: To implement CPOT and evaluate the impacts of CPOT implementation in the ICUs at NorthBay Medical Center and Vacavalley Hospital.
Methods: This evidence-based project utilized the IOWA Model of evidence-based practice change to implement CPOT. Nurses were provided education on CPOT for twenty minutes during mandatory quarterly ICU skills fairs in November 2017. The CPOT was implemented in both ICUs in April 2018. A descriptive study design was used to compare the before and after implementation groups. Forty patient charts were reviewed from the pre-implementation group and another forty patient charts were reviewed from the post-implementation group. Data was collected on number of pain assessments, pain reports, pain reassessments, amount of analgesia administered, ventilator days, and ICU days. Nursing feasibility and applicability survey were collected during pre-implementation and two months’ post-implementation.
Results: An inter-rater reliability of 93.3% from thirty pain observations was obtained during the pilot trial. There were no significant differences found between pre-and post-implementation groups in regards to pain assessment frequency, pain reports, analgesia usage, ventilator days, and ICU days. However, there was a statistically significant increase in the pain reassessment frequency (t=2.22, p=0.02). The mean of frequency of pain reassessment was 0.55 for the preimplementation group and 1.425 for the post-implementation group. Nursing survey results showed positive evaluations for CPOT with 100% of the nurses agreeing that CPOT is easy to use and 100% of the nurses agreed that they received adequate CPOT education. 95.9% of the nurses believed that CPOT helped to assess pain accurately in critically ill adult patients on ventilator and 93.8% believed that CPOT positively influenced their practice.

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