Implementing the Societal Impact of Pain in Spain WORKSHOP: - - PowerPoint PPT Presentation

Implementing the Societal Impact

• f Pain in Spain

WORKSHOP: Symposium “Societal Impact of Pain in Europe”

Hamburg, 23 September 2011

Mª Dolores Martín Rodríguez

Quality Programs Manager Galician Health Service. Spain

• 2.796.089 (INE 2009)
• Aged population
• Population dispersion

Population

• Hospitals: 15
• Primary Care Centres: 485
• IANUS: electronic medical record system for all primary care centers and

hospitals.

• Nursing care computer register system for all Hospitals: GACELA

Resources

• 1.088.878 patients receive care in Hospital Emergency Departments
• 245.225 hospital admissions/year
• 2.225.396 total days of hospital bed occupancy/year
• 189.666 Surgical interventions/year
• 25.806.646 Primary Care consultations

Healthcare Activities / year

• Cost per capita in Galicia 1.330 € (Spain 1.100 € - 1.600 €)

Healthcare costs

Galician Health Service

• Pain care strategies in 13

hospitals (87%).

• The existing methods for pain

care were based on chronic pain.

Pain Care

• Delivery of care.
• Structural elements.
• Records.
• Follow-up indicators.

Great Heterogeneity

Galicia: Pain Care situation 2010

ST RAT EG Y SERG AS 2014

PUBL IC HEAL T H C ARE a t the PAT IENT ’S SERVIC E

Strategic cores

Professionals: our greatest asset Professionals: our greatest asset

Quality and Patient Safety Quality and Patient Safety

Patients’ health and demands Patients’ health and demands Rigorous and efficient management Rigorous and efficient management Modernization of infrastructure Modernization of infrastructure Information and Technology Information and Technology Health sector as a value creator Health sector as a value creator

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

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

both the patient’s

and the family’s quality of life.

General Goals

Pain care = transversal strategy.

Pain care = Ethical value

Pain is a real problem with great impact

Pain counts with adequate and efficient

therapeutic options.

Ensuring the best care from a patient point

• f view, and care continuity.

Pain fifth vital sign

Patient participation Health care workers and Patient training and education

Specific Goals

Reinforce the bonds with health care

workers

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:

Situation Analysis

• Epidemiological
• Resource availability
• Pain care measures – Services Portfolio
• Drug prescription
• Qualitative Analysis

Methodology and actions carried out

• 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…

INITIAL LINE OF WORK:

We give priority to working the systematization and

implementation of the acute pain evaluation procedure in our hospitals.

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)

Procedure Systematization

Vital signs graph Pain as the 5th Vital Sign

• Pain Severity
• Pain origin
• Pain location
• Type of pain
• Characteristics
• Analgesic Effect
• Variation with movement
• Analgesia
• Associated symptoms

GACELA Pain Records

Final results of the evaluation

Nursing Care Plan

Audit Qualitative Quantitative Audit

Compliance with the implantation timetable Realization of informational/e ducational activities Healthcare workers’ adherence to the procedure Healthcare workers’ evaluation Problems identified Improvement suggestions

Level of compliance of the electronic register of pain (GACELA)

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT 18,4 26,8

% Patients Graph Record (VAS)

% Patientes graph record/ Total Patients (1st Trimester) % Patientes graph record/ Total Patients (2nd Trimester)

+ 8.4% 2011 Goal = 50% I nhospital patients

Results

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 100,0 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT 34,5 30,7

% Patient Pain Record VAS ≠ 0

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

10 20 30 40 50 60 70 80 90 100 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 TOT

Pain Intensity (May-July 2011)

GALI CI A

Mild Pain

57.2%

Moderate Pain

33.6 %

Severe Pain

10%

Results

Patients %

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

• ptimal 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
• Design and implementation of a training program for

professionals

• Design and implementation of a training program for patients /

caregivers

4th Trimester 2011

• Prioritization, and implementation of normalized processes of

care for different types of pain

• 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

2012

• 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

• f 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.

Conclusions

Thank you

Lola.martin.rodriguez@sergas.es

Santiago de Compostela