Date of Award

Summer 2023

Project Type


College or School




Program or Major


Degree Name

Master of Science

First Advisor

Kaitlynn Liset, MS, RN, CNL




Pain assessments in the post-anesthesia care unit (PACU) are crucial to recovery, the discharge process, patient outcomes, length of stay, and readmission rates. It is one of the main responsibilities of PACU nurses to adequately assess and treat pain when patients are in phase one and two of recovery after surgery. A thorough and accurate pain assessment tool is needed for these critically ill patients because not all of them are able to verbally express discomfort.

Local Problem

The problem that was identified during this quality improvement project was inconsistent initial pain assessments in the PACU. Patients arrive to the PACU in varying conditions, some conscious and some not. When it came to conducting pain assessments on patients, some nurses used the numerical pain scale, the Wong-Baker FACES scale, some would chart “unable to self-report” until the patient was conscious and could verbally express pain, and some would use the behavioral pain scale. This was leading to inconsistent pain assessments, and untreated pain in patients who arrived to PACU unconscious.


A literature review was conducted to review existing research and evidence about pain assessment tools used in the PACU. The Critical Care Pain Observation Tool (CPOT) was identified as a tool that was promising when it comes to pain assessments on unconscious patients but was lacking additional research. The CPOT was chosen for this quality improvement project to conduct additional research into its effectiveness.


The Critical Care Pain Observation Tool was used as the initial pain assessment tool in all PACU patients regardless of their level of consciousness. Nurses were educated on the CPOT scoring criteria and where to find the CPOT within the pain assessment documentation tab. The CPOT criteria was also available in the PACU bays, which allowed the nurses to start assessing pain while receiving report from the anesthesia provider and the operating room nurse.


The CPOT proved to be particularly useful in assessing pain in unconscious patients, although the numerical pain scale proved to be the preferred and most effective pain assessment tool for conscious patients as they are able to articulate their pain, describe it and the location, as well as give it a numerical rating.


The CPOT can be applied to many units because of the ability that it possesses to be applied to such a wide variety of patients of all ages, level of consciousness, and procedure/illness/injury. Additional research is still needed but there are promising results regarding the use of the CPOT in the same day surgical PACU setting.

Keywords: Pain assessment tool, PACU, CPOT, Critical Care, Quality Improvement, Improved pain assessments