TOWARDS A PAIN-FREE HOSPITAL

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TOWARDS A PAIN-FREE HOSPITAL

• Marco Visentin
• HPH network- Veneto, Italy

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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 !

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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

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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)

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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

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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

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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

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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

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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)

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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

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2 - BASIC SURVEYS

• prevalence of pain among the hospitals patients
• knowledge and attitudes of medical staff in the
  approach and treatment of pain-affected patients

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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

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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

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PAIN ASSESSMENT FEASIBILITY
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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

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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

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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

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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