According to the 2018 PADIS (Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption) guidelines, the Behavioral Pain Scale in intubated and nonintubated patients and the Critical-Care Pain Observation Tool have the greatest validity and reliability for monitoring pain in critically ill adults who are unable to self-report. These tools are both well validated for use in this population.

In these circumstances, we would still document both the pain level the patient is reporting and their behavior. It is also key to work collaboratively with the patient regarding treatment goals and desire for pain management. For example, you may say, “I see that you are rating your pain very high. Would you like something to manage it or do you feel that you have what you need? If you want some medication, would you like to start with some Tylenol or do you prefer something...

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