Using e-Learning Technology to Implement CPOT Education to a 6-Hospital Teaching System

The Critical Care Observation Tool (CPOT) is one of the most valid and reliable behavioral pain scales for monitoring pain in the critically ill. (Barr et al., 2013). Properly documenting a patient’s pain in the intensive care unit (ICU) lead to decreased incidence of delirium, less time on the ventilator and decreased stay in the ICU. Pain documentation options in ICUs in a 6-facility hospital system include the traditional pain numeric method, a FACES score and FLACC (face, Legs, activity, cry, consolability), which deemed reliable and valid in the pediatric population as opposed to the adult population. Nurses working in a large hospital system’s ICU serving a primarily adult and older adult population may have had some knowledge of the CPOT but were using other methods to determine pain in the patients who were unable to communicate. A gap analysis of current practice revealed the need to design an online learning course to provide training to each nurse in a 6-hospital system.

An E-learning course case-based scenario design was implemented to deliver the education to the critical care nurse. The intervention included a 40-minute online learning module with posttest of the CPOT developed by Gelinas et al (2010). The module consisted of 20 interactive slides that covered background, current pain methods commonly used, contraindications for use, video of a CPOT assessment and hands on fill in the blank, click and answer, and talking points with rationale for use of the CPOT. A posttest was required to ensure the learner understood how to use the tool, and for successful completion. Completion of the post-test was mandatory, and the learning module would not be marked complete in the learning management system until the learner completed all questions correctly (a post-test score of 100%). A preliminary review of the learning module was given to the nursing directors, and critical care educators with feedback for changes. Once changes were completed, the lesson was implemented system wide through email and ICU council meetings. Learning took place over 45 days.

A total of 699 employees completed the module. 2.8% of participants completed the modules with no retest, 19.7%, 21.8%, 19.4%, 11.9% and approximately 24% retested once, twice, three times, four times and five times or more respectively. Each facility’s campus had a critical care educator who worked in conjunction with the critical care nurses to complete the module. A total of 14 emails from various staff included questions about having trouble accessing the course. Themes of the email included "computer froze on slide 5, unable to access the module, and question# 4 is inaccurate." All items were addressed and the educators worked with the staff to provide access to the module. A 30-day follow-up random chart audit revealed that CPOT was being documented 35.6% of the time in that instance.

This was one of the first collaborations of a project with the critical care units for a system initiative. Limitations to the project were the inability to mandate the use of the CPOT in the clinical setting until the policy was updated. As there was no way to identify 100% of nurses the completion rate was unknown. Chart audits were reflective of the main campus; future projects will integrate all campuses. The policy had not been updated to reflect mandatory documentation of the CPOT, but strong recommendation was given. Policy since then has currently went into effect and all nurses in the system that work in ICU’s must use CPOT. The next step will be do chart review the ICU’s and determine the appropriate use of the CPOT. The CPOT tool is currently available for nurses to access in the e-learning system.