Pain as the fifth vital sign in Galicia: overcome challenge Mª Dolores Martín Rodríguez Quality...

Pain as the fifth vital sign in Galicia: overcome challenge

Mª Dolores Martín RodríguezQuality Programs Manager

Galician Health Service. [email protected]

Copenhagen, 30 May 2012

WS 3: Improving pain management: Delivering results in best practice cooperation models

mailto:[email protected]

Stra

tegi

c co

res

Professionals: our greatest asset

Quality and Patient Safety

Health and demands of citizens

Rigorous and efficient management

Modernization of infrastructure

Technology and information

Health sector as a creator of value

Integral Pain Care Strategy

Integral care procedures

Quality and Patient Safety Policies

Best practices in drug prescription and dispensation

Guarantee of care in time and form according to defined

pathologies

Paliative Care

STRATEGY SERGAS 2014 PUBLIC HEALTH CARE at the PATIENT’S SERVICE

Galicia: Pain Care Situation 2010Institutional Declaration

Galician Health Ministry

Implementation of the acute pain evaluation procedure in our hospitals: December 2011

Vital signs graphPain 5th Vital Sign

GALICIAN COMMISSION ON THE STRATEGY AGAINST PAIN

Decree 60/2012

• Director of Health CarePresident

• Autonomous Region of GaliciaScope

• To improve integral care policies on pain in the Galician Health Service

Goal

PresidentDirector of Health Care

Member1 person attached to

the department responsible for

Health Care

Member1 person attached to

the department responsible for Patient

Safety

Members4 Physicians

Member1 Pharmacist

Members4 nurses

Member1 psychologist

Members

2 persons belonging to the Patient

Advisory Council

Secretary

Person attached to the department responsible for Patient Safety

Vice-president

General Subdirector responsible for Patient Safety

Structure

14 members

REGISTER 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Average 2011

Inhospital Patients 61 553 61 173 54 921 59 184 220 727

Patients with pain record on vital signs chart

11 319 (18.4%)

16 397 (26.8%)

16 589(30.2%)

26 576(44.9%)

71 235 (32.3%)

Vital signs chart VAS record > 0 3 905 5 034 4 827 7 608 21 477

Qualitative record VAS> 0 3 901 5 409 5 545 7 223 22 075

Patients with pain record on vital signs chart VAS > 0 and Qualitative pain record

** 2 511 2 487 4 031 11 335

** 1st quarter data not available

GACELA (2011)

Integral Pain CareResults

DATA SOURCE: GACELA. Vital signs chart record 2011

Integral Pain Care


H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 AVERAGE SERGAS

0

10

20

30

40

50

60

70

80

29.332.1

12.6

6.8 6.8

24.7

32.9

42.4

69.2

43.2

72.2

38.635.4

7.2

32.3

% Patients with Pain Evaluation Record on vital signs Chart 2011Patients VAS >0 (N= 71 235)

STANDARD ≥50%

Average Galicia 2011 = 32.3


0

10

20

30

40

50

60

70

80

90

100

32.3

61.4

VAS Record in vital signs chart 2011-1st quarter 2012

% Patients with VAS record in vital signs chart 2011 % Patients with VAS record in vital signs chart 1st Quarter 2012

Integral Pain Care


(N= 37 842)(N= 71 235)

%

Integral Pain Care


0

10

20

30

40

50

60

70

36.1 34.4

27.9

59.5

48.7

33.5

48.3

56.7

15.3

21.0 21.5

29.1

21.5

52.5

30.1

% Patient refered Pain (VAS > 0)(N: 21 477)


Mild Pain Moderate Pain Severe Pain0

1000

2000

3000

4000

5000

6000

7000

8000 7 205

4 507

746

5 185

3 173

661

Female Male

Female Male

Age 0 - 17 18 - 39 40 - 59 ≥60 TOTAL 0 - 17 18 -39 40 - 59 ≥60 TOTAL

Patients VAS > 0 419 3.4% 4362 35.0% 2276 18.3% 5401 43.4% 12458 58.0% 564 6.3% 1129 12.5% 2161 24.0% 5165 57.3% 9019 42.0%

Mild Pain 239 3.3% 2618 36.3% 1254 17.4% 3094 42.9% 7 205 58.2% 342 6.6% 603 11.6% 1201 23.2% 3039 58.6% 5185 41.8%

Moderate Pain 163 3.6% 1534 34.0% 844 18.7% 1966 43.6% 4507 58.7% 196 6.2% 443 14.0% 788 24.8% 1746 55.0% 3173 41.3%

Severe Pain 17 2.3% 210 28.2% 178 23.9% 341 45.7% 746 53.0% 26 3.9% 83 12.6% 172 26.0% 380 57.5% 661 47.0%

Integral Pain CarePain Intensity

DATA SOURCE: GACELA. Vital Signs Chart Record 2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

57.7

35.8

6.6

% Mild pain 2011 % Moderate pain 2011 % Severe Pain 2011

Hospitals

Patie

nts

Patie

nts

Pain Intensity

N= 21 477

Integral Pain Care

No pain

Chest

left upper limb

Abdomen

right leg

0% 5% 10% 15% 20% 25% 30% 35% 40%

2.6%

12.0%

7.2%

8.0%

3.6%

4.0%

36.1%

9.7%

9.4%

7.4%

Pain Location (N= 22 112)

Not applicable

Diagnostic Procedure

Therapeutic Procedure

Immediately after surgery

Surgery

Medical condition

Trauma

Other

0% 5% 10% 15% 20% 25% 30% 35% 40%

8.9%

1.0%

3.8%

8.7%

15.3%

34.4%

14.4%

13.4%

Pain Origin (N= 22 112)

No

Diarrhea

Nausea /vomiting

Diarrhea/Nausea/Vomiting

Sweating

Fever/Sweating

hematoma / hemorrhage

Infection signs

weakness / paresthesias

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

78.6%

1.0%

5.7%

0.8%

2.9%

2.5%

1.7%

3.0%

3.5%

Associated Symptoms (N= 22 037)


No need

No scheduled analgesia

Oral analgesia

subcutaneous analgesia

Intermittent iv /4-6-8h

Continuous iv (infusion pump)

Iv. PCA

Epidural/spinal PCA

Transdermal patches

0% 10% 20% 30% 40% 50% 60%

6.4%

9.9%

23.8%

1.1%

52.7%

1.8%

1.0%

1.1%

2.2%

Analgesia (N= 22 112)

Not applicable

Disappears with analgesia

Decreases with analgesia

It does not decrease with analgesia

Required dose of rescue

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

16.9%

45.6%

32.2%

2.2%

3.0%

Analgesia Results (N= 22 112)

Integral Pain Care


Lines for Action 2012Child Pain Survey

Piloting indicators of chronic cancer pain

Systematization of chronic non cancer pain care procedures

Analysis of the current status of Pain Care Units in the Community

Chronic Pain Online course for healthcare professionals

Designing Education and Training Programs for patients

The implantation of the Integral Pain Care Strategy has allowed us to become aware of the real situation and thus put forth actions in order to improve health care procedures.

The creation of the Galician Commission on the Strategy Against Pain was greatly appreciated staff wise, specially by health professionals who work in Pain Units and primary care, as well as Scientific Societies and Patient Associations.

The collaborative work of members of the Commission results in numerous lines of work and contributions to improving patient care in pain.

Conclusions

THANK YOU FOR YOUR ATTENTION

Disclosure Statement of Financial Interest

I, Mª Dolores Martín Rodríguez, DO NOT have a financial interest/arrangement or affiliation with one

or more organizations that could be perceived as a real or apparent conflict of interest in the context of

the subject of this presentation.

Pain as the fifth vital sign in Galicia: overcome challenge Mª Dolores Martín Rodríguez Quality...

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