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

Journal article

Alotni, Majid A., Sim, Jenny, Chu, Ginger, Guilhermino, Michelle, Barker, Daniel, Szwec, Stuart and Fernandez, Ritin. (2025). Impact of implementing the critical-care pain observation tool in the adult intensive care unit : A nonrandomised stepped-wedge trial. Australian Critical Care. 38(2), p. Article 101129. https://doi.org/10.1016/j.aucc.2024.09.014
AuthorsAlotni, Majid A., Sim, Jenny, Chu, Ginger, Guilhermino, Michelle, Barker, Daniel, Szwec, Stuart and Fernandez, Ritin
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).

Keywordsnurse; pain; ICU; intensive care unit; stepped wedge; CPOT; adult
Year2025
JournalAustralian Critical Care
Journal citation38 (2), p. Article 101129
PublisherElsevier Inc.
ISSN1036-7314
Digital Object Identifier (DOI)https://doi.org/10.1016/j.aucc.2024.09.014
PubMed ID39489653
Scopus EID2-s2.0-85208036210
Open accessPublished as ‘gold’ (paid) open access
Page range1-7
FunderGovernment of Saudi Arabia
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online16 Jan 2025
Publication process dates
Accepted22 Sep 2024
Deposited08 May 2025
Additional information

© 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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