Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Jennifer Drumm

Committee Member

Dr. Melanie Hardin-Pierce


Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes.

Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management.

Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, agitation and patient outcomes. Descriptive data for analysis were extracted from 60 electronic medical records, 30 for both the pre- and post-implementation groups.

Interventions: The quality initiative included training sessions, unit champions, clinical support tools and the incorporation of the CPOT into unit pain management guidelines and several analgesic order sets.

Results: CPOT pain assessments (p < .001) were more frequent in the post-implementation group. There number of PRN analgesics were found to be greater in the post-implementation group, while the tendency for the total morphine equivalent dosage was lower. No differences were found between the pre- and post-implementation groups with regard to sedation and agitation management and patient outcomes.

Conclusions: The quality initiative was successful in increasing the routine use of the CPOT. Pain management of mechanically ventilated patients in this critical setting improved. Multidisciplinary participation and unit champions were vital to the success of this quality initiative.