Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

Mairi Mascarenhas, Michelle Beattie, Michelle Roxburgh, John Mackintosh, Noreen Clarke, Devjit Srivastava

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
114 Downloads (Pure)


Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff's reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

Original languageEnglish
Article numbere000304
Pages (from-to)1-8
Number of pages8
JournalBMJ Open Quality
Issue number4
Publication statusPublished - 9 Oct 2018


  • Control charts/run charts
  • Critical Care
  • pain
  • quality improvement
  • quality measurement


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