Introducing validated pain tools in the ICU: To improve pain assessment of the acute burn injured patient – Empowering patients and supporting clinicians

Ms Susan Taggart1, Ms Katina Skylas1, Dr  Janice Gullick2, Ms Alison Branelly1, Mr Mark Knapp1

1Concord Hospital, 2Sydney Nursing School, The University of Sydney

This study aimed to understand how ICU patients experience burn pain and to explore pain assessment practices, attitudes and beliefs among ICU clinicians pre and post the introduction of two pain assessment tools, the Numerical Rating Scale (NRS) and the Critical Care Observation Tool (CCPOT).

We engaged 10 patients and 13 clinicians in 35 semi-structured interviews which were analysed thematically. A retrospective chart review of 23 consecutive burn patients was also completed to look at pain assessment tools utilised, pain management and pharmacological interventions before and after the introduction of pain assessment tools.

Few patients had memories of pain during their transfer or the time in ICU. Most recalled regular pain assessment and described diverse sensory perceptions. Several described difficulty ascribing their pain experience to a number. Intubation caused communication difficulty, anxiety and discomfort. Pain became increasingly intrusive upon extubation and was reported as frequently overwhelming. Nurses reported that use of the CCPOT empowered them and allowed them to advocate for their patient.

Pharmacological interventions indicated an increase in Propofol, Ketamine, Fentanyl and Paracetamol post  implementation of the tools. Morphine use was lower post implementation. Midazolam use was reduced for larger burns but increased for smaller burns.

Burn pain creates challenges which are often related to levels of patient sedation and consciousness. The study has demonstrated benefits arising from the use of validated pain tools, in terms of reliability of pain assessment and communication. Larger sample sizes may be needed to yield more definitive evidence regarding pain assessment and management.

Sue’s current role is Clinical Nurse Consultant – Burns Support. This position focuses on coordinating the care of ICU patients who have sustained a burn or skin loss injury. She also coordinates the care of patients requiring Cultured Epithelial Autografts within the NSW Statewide Burn Injury Service.

The role also includes education and Sue often lectures on subjects including burns, wound pain, wound healing and critical care   nursing within the Sydney Local Health District, Sydney University, EMSB, NSW State-wide Burn Injury Service and the Australian College of Nursing. She is also a meditation facilitator for nurses at Concord Hospital.

Sue believes nursing is an art and a science and has a special and active interest in improving patient and family healing and care through research, quality projects and teaching.


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