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

2. PREVALENCE OF PAIN IN HOSPITALS
Donovan et al., %
Abbott et al., %
Visentin et al., %
Costantini et al., %
Gruppo italiano, %
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, and is internationally coordinated by the association “Ensemble contre la douleur” (Geneva, Switzerland)

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