TOWARDS A PAIN-FREE HOSPITAL

1. TOWARDS A PAIN-FREE HOSPITAL Marco Visentin HPH network- Veneto, Italy

2. PREVALENCE OF PAIN IN HOSPITALS • Donovan et al., 1987 79% • Abbott et al., 1992 50-67% • Visentin et al., 1999 44% • Costantini et al., 2000 43-56% • Gruppo italiano, 2001 46-91% the tragedy of needless pain !

4. PAIN IS NEGLECTED • pain is generally considered unavoidable • in medical practice pain is not considered a priority • medical staff often lack sufficient knowledge about pain • there are still barriers to the use of opioid analgesics

5. APS quality assurance standards for pain relief • Recognize and treat pain promptly (chart and display pain, levels to trigger review, pt satisfaction) • Information about analgesics • Promise patients attentive analg. care • Policies for use of advanced technologies • Monitor adherence to standards (American Pain Society, 1990)

6. AN INTERNATIONAL CAMPAIGN “Towards a pain-free hospital” was started in Montreal, Canada, 1992 and is internationally coordinated by the association “Ensemble contre la douleur” (Geneva, Switzerland) www.sans-douleur.ch

7. “TOWARDS A PAIN-FREE HOSPITAL” Belgique “vers un hôpital sans douleur” Canada “vers un hôpital sans douleur” France “vers un hôpital sans douleur” Italia “verso un ospedale senza dolore” España “hacia un hospital sin dolor” Suisse “vers un hôpital sans douleur” USA “towards a pain-free hospital”

8. PRINCIPLES OF THE CAMPAIGN • all the staff of every hospital dept. face the problem of pain • the whole hospital must be involved in the campaign • citizens should be involved as well

9. STAGES OF THE CAMPAIGN • creation of a steering committee • surveys (prevalence and knowledge) • education of staff • daily pain assessment • guidelines for pain treatment • information of citizens • monitoring of the campaign

10. 1-Committee “towards a pain free hospital” must include representatives of: • the hospital managemet • experts in pain treatment • the various care areas • the various professionals • nurses (at least one third of total)

11. 1-Committee“towards a pain-free hospital” duties: • co-ordination of the various tasks • observatory of the problem of pain • staff education and training • information to citizens • monitoring of the campaign

12. 2 - BASIC SURVEYS • prevalence of pain among the hospital’s patients • knowledge and attitudes of medical staff in the approach and treatment of pain-affected patients

13. 3 - COURSES FOR MEDICAL STAFF • different educational needs • involvement of nurses and doctors • presence of a psychologist • giving support after the course • continuing medical education

14. 4 - DAILY PAIN ASSESSMENT • the 5th vital sign • at least twice a day, by nurses • unidimensional tool (VAS, NRS) • register on the chart • effects on communication, attention, treatment

15. PAIN ASSESSMENT: FEASIBILITY

16. 5 - PAIN TREATMENT GUIDELINES • specific for the various care areas • intensity threshold which should trigger an analgesic prescription • sequential use of analgesics • policies for the use of advanced analgesic technologies

17. 6 - INFORMATION • to patients and citizens in general • importance of co-operating with medical staff for the assessment and treatment of their pain • the right to have pain controlled

18. 7 - INDICATORS • nurses’ compliance with daily pain assessment • organisation of courses on pain • preparation of treatment guidelines • informative material for patients • patients’ satisfaction • prevalence of pain, staff knowledge

20. The role of HPH • The project “towards a pain-free hospital” seems to fit well to HPH programs • In Italy 3 regional networks have adopted and started the campaign • The project will be proposed to all HPH networks