Pain assessment tools for the nonverbal critical care adult: an integrative review of the literature

Abstract

Patients in critical care often lack the ability to report the presence of pain due to conditions such as altered levels of consciousness, sedation, and endotracheal tubes. Untreated or poorly managed pain may lead to adverse psychological sequelae, a longer duration of mechanical ventilation, and an increased risk of infection. Several behavioral pain assessment tools are available to clinicians to improve their ability to detect the presence of pain. A large intensive care unit in the Northwest lacks a pain instrument for the assessment of pain in adult, non-verbal patients. An integrative review of the literature was performed from the years 2012-2017 to identify evidence-based pain instruments available for use in this population. Nine instruments were identified representing ten behavioral pain assessment tools. The Joanna Briggs Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework was utilized to determine the best instrument for implementation into a general intensive care unit. Based on the FAME criteria, the Critical Care Pain Observation (CPOT) is recommended for implementation for non-verbal patients in a general critical care unit.