ROLE OF A DEDICATED PAIN -NURSE IN THE PAIN FREE HOSPITAL PROJECT

1. ROLE OF A DEDICATED PAIN -NURSE IN THE PAIN FREE HOSPITAL PROJECT A. Veneziani, A. Appicciafuoco, F. Picca, A. Molisso , L. Garofolini, B. Librandi, I. Frati, V. Fusari Nuovo San Giovanni di Dio Hospital Florence - Italy

2. 2002: Adhesion of N. San Giovanni di Dio Hospital to the Pain Free Hospital HPH Project PAIN FREE HOSPITAL PROJECT

3. Joining the PFHP into an group of initiatives of Health Promoting Hospitals network HPH supported by Tuscany Region, empowered an additional authority to this plan. • Constituting the PFHP Committee, different leading professional figures, belonging to several distinct areas are been involved, choosing elements greatly motivated, with a pivotal role in their environment to strengthen the initiative. • Training, fundamental element to obtain a cultural and attitude change toward the patient’s pain.

4. Training planned on specific obiectives: • improving of the interdisciplinary communication • patient’s needs anticipation • pain measure and treatment anywhere the pain score is >3 • safety care of the patient • multi-professional involvement of all sanitary staff of pain assistance, to improve the team spirit and motivation of any different competence.

5. The greatest difficulty of a project involving a big cultural and aptitude changeover to patient pain relief, is to take care that the initial investment on hospital health staff training doesn’t remain fruitless.

6. The applicative phase, of which the nursing pain evaluation in the wards is the KEY ELEMENT, to guarantee an optimal (pain score <3) analgesia even with therapy adjustments, must be promptly carried out as soon as possible,andmay be critical. Anaesthetist Ward Nurses Administrators PATIENT Surgeon Pharmacist

7. Charlie Bronw Make pain visible What’s the difference between a Hospital….. and a Pain Free Hospital? ….that……. pain score is registered !

8. DEDICATED NURSE For this purpose, just from the beginning, nurses were stimulated and supported in pain scores recording and solving any problem by an applied dedicated nurse co-ordinating the postoperative pain control into an Acute Pain Service according to a model proposed by Prof Rawal Pain. 1994; 57:117-23 Ward Nurses Anaesthetist PATIENT Surgeon Pharmacist

9. Patients are enlisted in the operating theatre into a specific created program operating on a handled PC where kind of operation, anaesthetic treatment and analgesic prescriptions are input.

10. Postoperatively several parameters monitoring the patient condition, , the quality of analgesia and any side effect are recorded. A pain measure to implement the ward nurses recordings is assured to facilitate the therapy correction and its efficacy control

11. Nome Nome Nome Cognome Cognome Cognome Età Età Età Peso Peso Peso Allergie Allergie Allergie Note Note Note Assessment of pain Palm tops VAS P.C. Docking Station Electronic data base

12. IMPACT ON HOSPITAL • Greater sensibility to pain, which began to be considered and systematically measured like a vital sign in any surgical ward • 2004 increased analgesics consumption : • Morfin +12,5% • Paracetamol +55% • NSAIDs +105%

13. AVERAGE SURGICAL PAIN SCORE (VAS) 3-5 HOURS FROM THE TERM OF OPERATION N° 1078 patients

14. 2004 APN ACTIVITIES RESULTS

15. “Pain passes, sufferance remains.” (Buytendijk) Thank you