CPOT.pptx

critical care observation pain tools for intensive care unit.

1. PAIN CRITICAL CARE PAIN OBSERVATION TOOL (CPOT) PJK SUKINAH BT MANIAH SRN,SCM,ICU,BScN

2. PAIN Keys to good pain management . 1. Types of pain . 2. Assessment. 3. Management .

3. WHAT IS PAIN ? Pain is real regardless of its cause; pain is whatever the patient experiencing it says it is and exists where they say it does ( McCarthey 1983 ). The pain a patient describes may be seen as the tip of the iceburg , underlying this pain is a whole range of factors, physical, emotional, social and spiritual, each inextricably entwined (Saunders and Sykes 1983).

4. TYPES OF PAIN Types of Pain There are three types of pain: Visceral - tumour bulk, bowel obstruction Bone - replacement of bone by tumour , pathological fracture Neuropathic - nerve injury or nerve compression

5. ASSESSMENT Need psychosocial and medical history but also to ask: 1.Site of pain - where is the pain ? 2.Type of pain – what does it feel like ? 3.Frequency of pain – how often does it occur ? 4.Aggravating factors – what makes it worse ? 5.Relieving factors – what makes it better?

6. ASSESSMENT Disability – How does the pain affect everyday activities ? Duration of pain – how long has it been present ? Responses to previous and current treatments ? Meaning – what does the pain mean to the patient ? If you have a pain assessment tool, use it ! (Numerical ,visual )

7. PATIENTS THAT HAVE DIFFICULTY COMMUNICATING Facial expression . Posture. Increased agitation or aggression . Withdrawal. Change in mood and behaviour . Guarding one area of body . Not sleeping at night.

8. NURSING ROLES Remember the role of: Explanation Psychological Support Rest Relaxation Adequate sleep Heat padsTENs machine Massage Self-help measures

9. THE KEYS TO GOOD PAIN ASSESSMENT AND MANAGEMENT ARE Understanding the meaning of whole pain . Understanding of different causes of pain . Assessment of pain . Management of pain . Reassessment and monitoring.

10. Facial expressions * A score of 1 may be attributed when a change in the patient’s facial expression is observed compared with rest assessment (e.g. open eyes, tearing). Relaxed, neutral (no muscle tension) 1 Tense (frowning, brow lowering, orbit tightening, little levator contraction) 2 Grimacing (contraction of the whole face: frowning, brow lowering, eyes tightly closed, levator contraction – mouth may be opened or the patient may be biting the endotracheal Inspired by : Prkachin , K. M. (1992). The consistency of facial expressions of pain : a comparison across modalities. Pain, 51, 297-306.

11. CHART CPOT

12. The possible total score ranges from 0 (no pain) to 8 (maximum pain). The CPOT cutoff score was >2 during nociceptive procedures (7,12). A limitation of the CPOT is the lack of sufficient research in delirious critically ill patients.

13. It is estimated that up to 71% of ICU patients experience untreated pain. ( Gélinas 2007 ) The Society of Intensive Care Medicine recommends routine monitoring of pain in ICU patients . Treatment of pain is associated with fewer days on mechanical ventilation, decreased infections and increased satisfaction . The CPOT is an innovative pain assessment tool that is based on 2 preliminary studies with expert selected variables, prior research of behavioral indicators for pain and vigorously compared scores at varying levels of consciousness. WHY CPOT ?

14. REFFERENCES Researcher Centre for Nursing Research Jewish General Hospital 3755 Cote Sainte Catherine Road, Room H-301.2 Montreal, Qc H3T 1E2 Canada Phone: [phone] ext.4645 1. Pekeliling Ketua Pengarah Kesihatan Bilangan 9 Tahun 2008.: Pelaksanaan Tahap Kesakitan Sebagai Tanda Vital Kelima (Pain as Fifth Vital Sign) di Hospital-hospital Kementerian Kesihatan . Bahagian Perkembangan Perubatan , Kementerian Kesihatan Malaysia, 2008. 2. Camppeu D. et al 2003: Review of Acute Pain Management in Victoria. Available at: www.health.vic.gov.au 3. Griffie , McKinnon, Berry, & Heidrich , 2002 4. Joint Commission on Accreditation of Healthcare Organizations (2003). 2003 Hospital Accreditation Standards. Effective January 1, 2001. Available at: www.jcaho.org/newsroom/healthcare 5. Jacox et.al.1992: ABCD of Pain Management & Pain Assessment. 6. Merskey H & Bogduk N. Classification of Chronic Pain. 2 ed. Seattle: International Association for the Study of Pain; 1994. 7. Wendler R. Pain: The Fifth Vital Sign. Hospitals Adopt New Pain Management Measures, Texas Medical Center News, Vol. 23, No. 1 8. Wong D, Baker C 1988. Pain in children: Comparison of assessment scales. Pediatric Nursing 14:9-17.

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