Assessment and Management Strategies
Adult ICU patients routinely experience pain, both at rest and with routine ICU care such as procedures or wound care. Lack of treatment of pain can result in many complications including delirium. The PAD Guidelines (2013 PAD SCCM/ACCP Guidelines) suggest that pain be routinely monitored in all adult ICU patients. Self- reporting is the gold standard for assessment of pain. Vital signs should not be used alone for assessment of pain in patients that are unable to communicate. The Behavioral Pain Scale (BPS) and the Critical‐Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for assessing pain in adult, ICU patients unable to communicate pain.
The CPOT includes evaluation of four different behaviors (facial expressions, body movements, muscle tension, and compliance with the ventilator for mechanically ventilated patients or vocalization for nonintubated patients) rated on a scale of zero to two with a total score ranging from 0 to 8. The CPOT is feasible, easy to complete, and simple to understand.