News: AACN Practice Alert Addresses Pain Assessment

Editorial Contact:
Kristie Aylett
AACN Communications
(228) 229-9472

American Association of Critical-Care Nurses issues Practice Alert on assessing patients’ pain

Assessing presence and intensity of pain impacts patient outcomes

ALISO VIEJO, Calif. — August 8, 2013 — The American Association of Critical-Care Nurses (AACN) aims to standardize how nurses evaluate patients for pain, especially when patients are unable to speak.

A new AACN Practice Alert, “Assessing Pain in the Critically Ill Adult,” provides evidence-based recommendations and supporting documentation on assessing pain in critically ill patients, many of whom experience significant pain during hospitalization.

For example, more than 30 percent of patients in intensive care units (ICUs) have significant pain at rest, and more than half have significant pain during routine care.

The challenge to assessing pain is that many critically ill patients cannot describe how they feel, due to their condition, sedation or mechanical ventilation.

Untreated pain can lead to complications and chronic disabling pain. Furthermore, the lack of pain assessment or an incomplete assessment has been associated with death in the ICU.

“The gold standard is for patients to tell nurses directly about any pain, but many critically ill patients are unable to do that,” said AACN Senior Director Ramón Lavandero, RN, MA, MSN, FAAN. “If patients are unable to self-report, validated pain assessment tools should be used as standard practice.”

Based on the latest available evidence, this AACN Practice Alert summarizes expected nursing practice related to pain assessment, including:

  • Attempt to obtain the patient’s self-report of pain using validated pain assessment tools or simple questions.
  • Perform a pain assessment for critically ill adults who are unable to self-report, using a validated behavioral pain scale, such as the Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT).
  • Avoid referring primarily to vital signs for pain assessment of critically ill adult patients.
  • Consider, as a proxy, asking someone who knows the patient well to identify behavior that may indicate pain.

The Practice Alert will also help hospitals implement the “Clinical Practice Guidelines for the Management of Pain, Agitation and Delirium in Adult Patients in the Intensive Care Unit,” issued earlier this year by the Society of Critical Care Medicine (SCCM).

To further help hospitals put the new guidelines into practice, AACN is devoting three sessions of its monthly AACN Critical Care Webinar Series to this high-interest clinical issue.

This Practice Alert is the latest in a series of clinical resources issued by AACN to support standardization of practice and update nurses and other healthcare providers on new healthcare advances and trends. All alerts are available on the AACN website,

Supported by authoritative evidence, each AACN Practice Alert seeks to ensure excellence in practice along with promotion of a safe and humane work environment.

Topics address both nursing and interprofessional activities of importance to patients in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

Additional alerts address ventilator associated pneumonia, pulmonary artery pressure monitoring, dysrhythmia monitoring, ST segment monitoring, family presence during resuscitation and invasive procedures, and verification of feeding-tube placement.

AACN Practice Alerts can be downloaded free of charge at

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, Calif. 92656-4109;
Phone: (949) 362-2000; Fax: (949) 362-2020;;;

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