(1275) A Survey of Current Pain Assessment Practices for Unresponsive Patients in the ICU

Introduction: The Society of Critical Care Medicine’s clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU, recommend frequent assessments of pain. Based on these standards, pain assessments are done every 1-4 hours in ICUs. However, despite its importance, implementing frequent, consistent, and accurate pain assessments remains a challenge in the ICU. To clarify gaps between the recommendations and current practices, we surveyed the current practice patterns for unresponsive (unconscious or deeply sedated) ICU patients.

Methods: An online survey of ICU nurses in the U.S. was conducted using SurveyMonkey. The questions in the survey included respondents' demographics, types of pain scales used, the frequency of pain assessment recommended in their ICU policy, their actual assessment frequency, the assessment duration, and concerns related to pain assessment. Finally, we conducted cross analysis to analyze the current pain assessment practices.

Results: In total, 112 ICU (male, 76; female, 36), out of 167 nurses, from 19 different states across the United States completed the survey. They worked at several ICUs (cardiac, 31.3%; surgical, 28.6%; neuro, 16.1%; and medical, 24.1%). The most frequently used pain assessment scale was the Behavioral Pain Scale (BPS, 40.2%), followed by Critical Care Pain Observation Tool (CPOT, 33.0%). 32.1% of ICU nurses were not able to follow their ICU policy for pain assessment frequency. In particular, the higher the frequency recommended in the ICU policy, the lower was the actual adherence rate. Among the ICU nurses who used CPOT or BPS, 41.5% spent less than 30 seconds for their pain assessment per patient, although CPOT usually takes around 60 seconds. Over half of ICU nurses were concerned that they were too busy to conduct accurate and detailed pain assessment.

Conclusions: Our survey revealed that adherence to existing ICU policy for frequent pain assessment can be challenging due to the limited time available and details needed to assess in the available scales. Future improvements using artificial intelligence-supported assessments are likely to promote better adherence to guidelines and improve patient outcomes.