Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Summary Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of p...

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Published in:	Anaesthesia Vol. 72; no. 6; pp. 737 - 748
Main Authors:	Bantel, C., Gordon, F., Brett, S. J., Laycock, H. C., Bantel, Carsten, Gooneratne, Mevan, Hopkins, Phil, Johnston, Carolyn, Odor, Peter, Laycock, Helen, Martin, Daniel, O'Carroll, James, Phillips, Sioned, Visram, Anil, Siddique, Omar, Burdett, Edward, May, Rosie, Renwick, Sonia, Gray, Martin, Spiro, Michael, Chamarette, Holly, Young, Trudy, Wagstaff, Duncan, Lewith, Henry, Gowrie, Shan, Collison, Lucy, Mansell, Josephine, Hamilton, Kevin, Dawson, Jeremy, Morkane, Clare, Balla, Paul, Shukla, Bhavin, Rublotta, Francesca, Cousins, Jonathan, Magee, David, Cashell, Catherine, Kooner, Gurleen, Arnold, Glenn, Garnelo Ray, Vanessa, Clancy, Olivia, Whitehead, Nicole, Vizcaychipi, Marcella, Edwards, Zara, Addy, Melissa, Jhanji, Shaman, Wigmore, Tim, Sidon, Lauren, Grover, Munita, Panagoda, Prasan, Howells, Lara, Cartwright, Charles, Griffith, Megan, Casely, Emma, Holdgate, Andrew, Rich, Stephanie, Henriksson, Maria, Tatham, Kate, Kadry, Mirian, Finlay, Claire, Pandit, Ajoy, Ong, Cheng, Bidd, Heena, Ramessur, Suneil, Anwar, Sibtain, Blunt, Nadia, Williams, Hannah, Tosini, Chiara, Kumar, Ravi, Ferrier, Victoria, Gupta, Aman, Carey, Ben, Somasundaram, Karthik, Silva, Samanthi, Moghulm, Arif, Dua, Kanika, McHugh, Barry, Chapman, Rachel, Sangam, Amy, Gowripalann, Tharumalingam, Kunnumpurath, Sreekumar, Mottaleb, Ramy, Eeles, Alex, Hunningher, Annie, Nesbit, Finn, Turton, Danny, Barringer, Chris, Dannatt, Peter, Shenoy, Venkat, Keogh, Peter, Krishnachetty, Bobby, Ferns, Janis, Kennedy, Charles, Husain, Naush, Holler, Liesel, Barnes, Lucy, Thorburn, Patrick, Shippam, William, Lee, Sindy, Mahgoub, Sara
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-06-2017 John Wiley and Sons Inc
Subjects:	Adult Aged Aged, 80 and over Analgesia Assessments critical care Critical Care - methods Female Guidelines Hospitals Human behavior Human factors Humans Intensive care intensive care unit Intensive care units Intensive Care Units - statistics & numerical data Length of Stay Male Medical personnel Middle Aged Nurses Nursing Nursing - statistics & numerical data Nursing Assessment Observational studies Original Ostomy Pain pain assessment Pain Measurement - methods Pain Measurement - statistics & numerical data Pain perception pain terms Pain, Postoperative - diagnosis Pain, Postoperative - therapy Patients Physicians Physicians - statistics & numerical data Retrospective Studies Surgery Surgical instruments Tracheostomy United Kingdom Young Adult United Kingdom critical care pain assessment pain terms intensive care unit physicians
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Summary:	Summary Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.
Bibliography:	http://www.anaesthesiacorrespondence.com You can respond to this article at ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 See Appendix 2 for the full list of named PLAN and SEARCH contributors and affiliated institutions. You can respond to this article at http://www.anaesthesiacorrespondence.com
ISSN:	0003-2409 1365-2044
DOI:	10.1111/anae.13786