NON-COMMUNICATIVE PATIENT’S PAIN ASSESSMENT IN THE INTENSIVE CARE UNIT. A LITERATURE REVIEW

S. Marino¹, M.G. Scarcella¹, V. Chelo², A. Alberti¹, S. Tinti¹ | ¹ASST Rhodense, Garbagnate Milanese; ²Degree in Nursing, University of Milan, Rho Campus

INTRODUCTION
Pain assessment in non-communicating patients is a frequent issue in ICUs. Inadequate symptom assessment and management results in increased co-morbidity and mortality. The Joint Commission on Accreditation of Healthcare Organizations requires in its quality standards that all patients be evaluated for pain and receive appropriate treatment. The guidelines recommend a validated tool adoption to assess pain, such as the use of behavioral scales. The study aim was to review the literature to identify an appropriate pain assessment tool to be introduced into the Intensive Care Nursing Plan of a Northern Italy hospital in order to ensure accurate pain assessment in non-communicating patients undergoing endotracheal intubation and sedation.
METHODS
A literature review was conducted; CINAHL, PUBMED, SCOPUS, ILISI and JOANNA BRIGGS INSTITUTE databases were consulted. Inclusion criteria included articles published from 2014 to 2024, in Italian and English, about adult patients (>18 years old) admitted to ICUs and undergoing endotracheal intubation and sedation.
RESULTS
Seventeen articles included showed that the recommended approach to assess pain in the non-communicative patient is the use of a behavioral scale. The validated tools available in Italian are the ‘Critical-Care Pain Observation Tool-(C-POT)’ and the ‘Behavioral Pain Scale-(BPS)’, both valid and reliable. Additional innovative tools (pupillometry, semiautomated monitoring system, 'Near Infrared Spectroscopy', bispectral index) are potentially useful but need further investigation in future studies to be introduced into clinical practice.
CONCLUSIONS
There are two validated tools available in Italy, C-POT and BPS, both valid and reliable. BPS measures pain in sedated non-tetraplegic patients, simplifying assessment and able to improve pain management and quality of care. The C-POT is among the better tools currently available for ICU patients who also do not communicate in terms of its comprehensibility and ability to discriminate between different levels of pain supporting its usefulness and applicability in the clinical setting. Considering its adoption and designing training courses related to its use, including a cascade training system, would be useful.