Development of a pain management algorithm for intensive care units

Brita F Olsen; Tone Rustøen; Leiv Sandvik; Christine Miaskowski; Morten Jacobsen; Berit T Valeberg

doi:10.1016/j.hrtlng.2015.09.001

Development of a pain management algorithm for intensive care units

Heart Lung. 2015 Nov-Dec;44(6):521-7. doi: 10.1016/j.hrtlng.2015.09.001.

Authors

Brita F Olsen¹, Tone Rustøen², Leiv Sandvik³, Christine Miaskowski⁴, Morten Jacobsen⁵, Berit T Valeberg⁶

Affiliations

¹ Østfold Hospital Trust, Fredrikstad, Norway; Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway. Electronic address: Brita.Fosser.Olsen@so-hf.no.
² Oslo University Hospital, Division of Emergencies and Critical Care, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
³ Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
⁴ School of Nursing, University of California, San Francisco, CA, USA.
⁵ Østfold Hospital Trust, Fredrikstad, Norway; Faculty of Medicine, University of Oslo, Norway; Norwegian University of Life Sciences, Aas, Norway.
⁶ Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

PMID: 26572773
DOI: 10.1016/j.hrtlng.2015.09.001

Abstract

Objectives: To develop a pain management algorithm for intensive care unit (ICU) patients and to evaluate the psychometric properties of the translated tools used in the algorithm.

Background: Many ICU patients experience pain. However, an evidence-based algorithm for pain management does not exist.

Methods: Literature review, expert panel, and pilot testing were used to develop the algorithm. The tools were evaluated for inter-rater reliability between two nurses. Discriminant validity was evaluated by comparing pain during turning and rest.

Results: An algorithm was developed. The Behavioral Pain Scale (BPS) and the Behavioral Pain Scale-Non Intubated (BPS-NI) discriminated between pain scores during turning and rest. Inter-rater reliability for the BPS varied from moderate (0.46) to very good (1.00). Inter-rater reliability for the BPS-NI varied from fair (0.21) to good (0.63).

Conclusions: The content of the pain management algorithm is consistent with the latest clinical practice guideline recommendations. It may be a useful tool to improve pain assessment and management in adult ICU patients.

Keywords: Acute pain; Critical care; Intensive care unit; Pain assessment; Pain management; Pain management algorithm.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Algorithms*
Critical Care / methods*
Critical Illness / therapy*
Humans
Intensive Care Units*
Pain Management / methods*
Pain Measurement / nursing
Reproducibility of Results