A. Veneziani, A. Appicciafuoco, F. Picca, A. A. Veneziani, A. Appicciafuoco, F. Picca, A. Molisso , L. Garofolini, B. Librandi, I. Molisso , L. Garofolini, B. Librandi, I.

Frati, V. FusariFrati, V. Fusari

Nuovo San Giovanni di Dio Hospital Nuovo San Giovanni di Dio Hospital

Florence - ItalyFlorence - Italy

PAIN FREE HOSPITAL PROJECTPAIN FREE HOSPITAL PROJECT

2002: Adhesion of N. San Giovanni di 2002: Adhesion of N. San Giovanni di Dio Hospital to the Pain Free Hospital Dio Hospital to the Pain Free Hospital

HPH ProjectHPH Project

• Joining the PFHP into an group of initiatives of Joining the PFHP into an group of initiatives of

Health Promoting Hospitals network HPH Health Promoting Hospitals network HPH

supported by Tuscany Region, empowered an supported by Tuscany Region, empowered an

additional authority to this plan. additional authority to this plan.

• Constituting the PFHP Committee, different leading Constituting the PFHP Committee, different leading professional figures, belonging to several distinct professional figures, belonging to several distinct areas are been involved, areas are been involved, choosing elements choosing elements greatly motivated, with a pivotal role in their greatly motivated, with a pivotal role in their environmentenvironment to strengthen the initiative. to strengthen the initiative.

• Training, fundamental element to obtain a cultural Training, fundamental element to obtain a cultural

and attitude change toward the patient’s pain. and attitude change toward the patient’s pain.

• improving of the interdisciplinary improving of the interdisciplinary communication communication

• patient’s needs anticipationpatient’s needs anticipation• pain measure and treatment anywhere pain measure and treatment anywhere

the pain score is >3the pain score is >3• safety care of the patientsafety care of the patient• multi-professional involvement of all multi-professional involvement of all

sanitary staff of pain assistance, to sanitary staff of pain assistance, to improve the team spirit and motivation improve the team spirit and motivation of any different competence.of any different competence.

Training planned on Training planned on specific obiectives:specific obiectives:

is to take care that the initial is to take care that the initial investment on hospital health investment on hospital health staff training doesn’t remain staff training doesn’t remain fruitless. fruitless.

The greatest The greatest difficulty of a difficulty of a project involving project involving a big cultural and a big cultural and aptitude aptitude changeover to changeover to patient pain patient pain relief, relief,

Administrators

Anaesthetist

SurgeonPharmaci

st

PATIENTPATIENT

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, and may be critical.

Ward Nurses

What’s the difference What’s the difference

between a Hospital….. between a Hospital…..

and a Pain Free and a Pain Free

Hospital?Hospital?

BronwBronw CharlieCharlie

…….that……. .that…….

pain score is registered !pain score is registered !

Anaesthetist

Surgeon

Pharmacist

PATIENTPATIENT

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

Ward Nurses

DEDICATED NURSEDEDICATED NURSE

Pain. 1994; 57:117-Pain. 1994; 57:117-2323

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

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

Nome

Cognome

Età

Peso

Allergie

Note

Nome

Cognome

Età

Peso

Allergie

Note

Nome

Cognome

Età

Peso

Allergie

Note

P.C.

Docking StationDocking Station

Palm topsPalm tops

Assessment of painAssessment of pain

Electronic data baseElectronic data base

VASVAS

IMPACT ON HOSPITALIMPACT ON HOSPITALGreater sensibility to pain, which Greater sensibility to pain, which began to be considered and began to be considered and systematically measured like a vital systematically measured like a vital sign in any surgical wardsign in any surgical ward

2004 increased analgesics 2004 increased analgesics consumption :consumption :– Morfin +12,5%Morfin +12,5%– Paracetamol +55%Paracetamol +55%– NSAIDs +105%NSAIDs +105%

AVERAGE SURGICAL PAIN SCORE AVERAGE SURGICAL PAIN SCORE (VAS) 3-5 HOURS FROM THE (VAS) 3-5 HOURS FROM THE

TERM OF OPERATIONTERM OF OPERATION

3,02

2,47

0

0,5

1

1,5

2

2,5

3

3,5

Jan-May 2004 June-Dec.2004

N° 1078 N° 1078 patientspatients

2004 APN ACTIVITIES 2004 APN ACTIVITIES RESULTSRESULTS

Average Apn Per PatientSurvey 3.28

Number Of Apn TherapyCorrections 576

““Pain passes, sufferance Pain passes, sufferance remains.”remains.”

(Buytendijk)(Buytendijk)

Thank you