The American Association of Critical-Care Nurses has released a practice alert that provides evidence-based recommendations and supporting documentation on assessing pain in critically ill patients.
Many such patients experience significant pain during hospitalization, the AACN noted in a news release. For example, more than 30% of patients in ICUs have significant pain at rest, and more than half have significant pain during routine care.
The challenge to assessing pain is that many critically ill patients cannot describe how they feel due to their condition, sedation or mechanical ventilation, according to the news release. Untreated pain can lead to complications and chronic disabling pain. Furthermore, the lack of pain assessment or an incomplete assessment has been associated with death in the ICU.
If patients are unable to self-report, validated pain assessment tools should be used as standard practice, said AACN Senior Director Ramón Lavandero, RN, MA, MSN, FAAN.
Based on the latest available evidence, the practice alert summarizes expected nursing practice related to pain assessment, including:
Attempt to obtain the patients self-report of pain using validated pain assessment tools or simple questions;
Perform a pain assessment for critically ill adults who are unable to self-report, using a validated behavioral pain scale, such as the Behavioral Pain Scale or the Critical-Care Pain Observation Tool;
Avoid referring primarily to vital signs for pain assessment of critically ill adult patients;
Consider, as a proxy, asking someone who knows the patient well to identify behavior that may indicate pain.
The practice alert is the latest in a series of clinical resources issued by the AACN to support standardization of practice and update nurses and other healthcare providers on new healthcare advances and trends. All alerts are available on the AACN website: www.aacn.org/practicealerts.
The practice alert also will help hospitals implement the Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium in Adult Patients in the Intensive Care Unit,” issued earlier this year by the Society of Critical Care Medicine: http://bit.ly/1bfS1Dy.