Implementing the Societal Impact of Pain in Spain WORKSHOP: Symposium “Societal Impact of Pain in Europe” Mª Dolores Martín Rodríguez Hamburg, 23 September 2011 Quality Programs Manager Galician Health Service. Spain
Galician Health Service • 2.796.089 (INE 2009) Population • Aged population • Population dispersion • Hospitals: 15 • Primary Care Centres: 485 Resources • IANUS: electronic medical record system for all primary care centers and hospitals. • Nursing care computer register system for all Hospitals: GACELA • 1.088.878 patients receive care in Hospital Emergency Departments Healthcare • 245.225 hospital admissions/year Activities / • 2.225.396 total days of hospital bed occupancy/year • 189.666 Surgical interventions/year year • 25.806.646 Primary Care consultations Healthcare • Cost per capita in Galicia 1.330 € (Spain 1.100 € - 1.600 €) costs
Galicia: Pain Care situation 2010 • Pain care strategies in 13 hospitals (87%). Pain Care • The existing methods for pain care were based on chronic pain. • Delivery of care. Great • Structural elements. Heterogeneity • Records. • Follow-up indicators.
EG Y SERG AS 2014 ST RAT PUBL IC HEAL T H C ARE a t the PAT IENT ’S SERVIC E
Integral Pain Care Patients’ health and demands Patients’ health and demands Strategy Quality and Patient Safety Quality and Patient Safety Strategic cores Integral Care Procedures Professionals: our greatest asset Professionals: our greatest asset Quality and Patient Safety Information and Technology Information and Technology Policies Health sector as a value creator Health sector as a value creator Best Practices in drug prescription and dispensation Rigorous and efficient management Rigorous and efficient management Guarantee of care in time Modernization of infrastructure Modernization of infrastructure and form according to defined pathologies
General Goals Improvement when providing care to in ‐ patients , by means of implementing a global strategy directed towards optimal pain management , both standardized and equitable , for all patients and, in this way, obtaining “pain free hospitals”. Improve the patient’s and the family’s both quality of life.
Specific Goals Ensuring the best care from a patient point of view , and care continuity . Pain counts with adequate and efficient therapeutic options . Pain is a real problem with great impact Pain care = transversal strategy . Pain care = Ethical value Reinforce the bonds with health care workers Pain fifth vital sign Patient participation Health care workers and Patient training and education
Methodology and actions carried out Establish Bonds with Scientific Societies •Galician Pain Society •National Pain Society Project Presentation •Galician Health Service Directors •Healthcare workers •Patients Legislation for Constitution of a Galician Assessment Committee on Pain •Members: Management representatives of the Galician Health Service, Physicians; Nurses ; Psychologists and Pharmacists. •Functions: • Advise on pain care • Unify resource utilization criteria • Standardize care procedures • Resports and studies of interest to the Community • Effectivenss Monitoring Strategy: indicators • Define training programas for health care professionals and patients • Define lines of patient participation… Situation Analysis •Epidemiological •Resource availability •Pain care measures – Services Portfolio •Drug prescription •Qualitative Analysis
INITIAL LINE OF WORK: We give priority to working the systematization and implementation of the acute pain evaluation procedure in our hospitals.
Procedure Systematization Constitution of a multidisciplinary Work Group made up of hospital members of the Galician Health Service. Procedure consensus among all hospitals (Groups/pain committee). Inclusion: - VAS. - Faces Pain Scale. Setting up a pain record in the management of care computer application GACELA. Follow-up indicator systematization involving adherence to the procedure by healthcare workers and its impact on patients (Dec/2010)
Vital signs graph Pain as the 5th Vital Sign
GACELA Pain Records Pain Severity Pain origin Pain location Type of pain Characteristics Analgesic Effect Variation with movement Analgesia Associated symptoms
Final results of the evaluation
Care Plan Nursing
Audit Compliance with the implantation timetable Qualitative Realization of Improvement informational/e suggestions ducational activities Audit Healthcare Problems workers’ identified adherence to the procedure Healthcare workers’ evaluation Quantitative Level of compliance of the electronic register of pain (GACELA)
Results % Patients Graph Record (VAS) 90,0 80,0 70,0 2011 Goal = 50% I nhospital patients 60,0 50,0 + 8.4% 40,0 26,8 30,0 18,4 20,0 10,0 0,0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT % Patientes graph record/ Total Patients (1st Trimester) % Patientes graph record/ Total Patients (2nd Trimester)
Results % Patient Pain Record VAS ≠ 0 100,0 90,0 80,0 70,0 60,0 50,0 40,0 34,5 30,7 30,0 20,0 10,0 0,0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT Patient pain record ≠ 0/Total Patientes with graph pain record (1st Trimester) Patient pain record ≠ 0/Total Patientes with graph pain record (2nd Trimester)
Results Pain Intensity (May-July 2011) 100 GALI CI A 90 80 Mild Pain 70 57.2% Patients % 60 Moderate 50 Pain 33.6 % 40 30 Severe Pain 10% 20 10 0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT
The main areas up for improvement which were identified are the following The need to continue working in training nursing staff. To have a ruler available which combines the various types of scales involving pain evaluation. Difficulties of some staff members when registering computer data. In some departments the lack of time does not permit patient evaluation in an optimal manner. Intensive care units do not have the GACELA nursing care computer application. This data is recorded on paper. Health staff evaluate the procedure in a positive way and think it was necessary.
Actions 2011-2012 • Constitute the Galician Assessment Committee on Pain 4 th Trimester • Design and implementation of a training program for professionals 2011 • Design and implementation of a training program for patients / caregivers • Prioritization, and implementation of normalized processes of care for different types of pain 2012 • Design and implementation of indicators in the scorecard for monitoring and evaluating the effectiveness of the strategy/ processes • Design and implementation of a procedure for information and feedback to professionals and patients
Conclusions - The acute pain evaluation procedure is set up in all hospitals. - The pain register procedure is set up in all hospitals. - We have a monitoring system with common indicators The implantation of the Integral Pain Care Strategy by the Management of the Galician Health Service was greatly appreciated staff wise, specially by healthcare workers who work in Pain Units as well as Scientific Societies and Patient Associations. Collaborative multidisciplinary work has resulted in great enrichment for those people who, like me, have worked on this project as well as for those hospitals who have shared their experiences and their best practices. Healthcare staff have valued very positively the patients’ vision as to their passage through the health system and how satisfied they are to have their needs and expectations met in relation to the care received.
Santiago de Compostela Thank you Lola.martin.rodriguez@sergas.es
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