HEALTH POLICIES TO CONTRAST PAIN IN FERRARA UNIVERSITY HOSPITAL (Emilia Romagna Region, Italy) - PRELIMINARY RESULTS-

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1 SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara 19th International Conference on Health Promoting Hospitals & Health Services Turku, June 2011 HEALTH POLICIES TO CONTRAST PAIN IN FERRARA UNIVERSITY HOSPITAL (Emilia Romagna Region, Italy) - PRELIMINARY RESULTS- Teresa MATARAZZO, Ermes CARLINI, Paola ANTONIOLI, Sandra BOMBARDI, Paola CAPONCELLI, Giuseppe GILLI, Elena FORINI, Chiara BORGHI, Comitato Ospedale Territorio Senza Dolore COTSD, Ilaria MORGHEN, Fulvia BALBONI, Gabriele RINALDI.

2 Pain is the most dreaded symptom between patients and their relatives persistence of prejudice low grade of priority undervaluation no/low low integration between professionals and specialists problems in assistential continuity in and out hospital multy-disciplinary approach diagnostic-therapeutic path assistential continuity hospital/land The patient is the centre of the Health system

3 Cultural change Spread attention to the person: humanize medical treatment Prevenction of cronicization and injuries Stimulate clinical appropriateness Control clinical risk Coordinate actions and structures involved in health: it s necessary to create a system, a network

4 OBSTACLES FOR THE CHANGE ADMINISTRATIONAL-ORGANIZATIONAL CONTEXT ECONOMICAL DISINCENTIVES PATIENTS AND CITIZENS EXPECTATIONS LEGAL PROBLEMS BORDERS PROFESSIONAL CULTURE CONTEXT CLINICAL APTITUDES CONSOLIDATE HABITS LOCAL LEADERS OPINIONS EDUCATION/BACKGROUND CLINICAL UNCERTAINTY SENSE OF COMPETENCE COMPULSION TO ACT

5 THE PROJECT Pain-free Hospital Provision 24/05/2001, OG n. 149, Law n.15, 29/06/2001 The project became Pain-free Hospital and Land at the moment of the enactment of law n.38/may 2010

6 PAIN-FREE HOSPITAL AND LAND COMMITTEE Italian Guidelines O. J. n 149, 29/06/2001 and Law38/2010 The tasks: To be a specific observatory on pain To promote training of sanitary staff To provide opiates availability To take part and check guidelines enforcement To promote information

7 Law n. 38/2010 It is obligatory to monitor pain in the patient s hystory The project becomes Painfree Hospital and Land It s easier to gain access to some painkillers (particularly opiates) Medical and sanitary staff education National networks interested in palliative care and pain therapy

8 SOME PAST ACTIONS OF PFHLC (COTSD) IN OUR HOSPITAL.. Cultural process: to sensitize the involved staff Validated pain scales to assess pain in adults (NRS) and children (FPS) Information and education of patients: they have to say when they feel pain The network Pain Free Hospital and land,100 operators in the whole hospital Recommendations for the treatment of Post-Operative pain and of pain in Medical Area Integrated patient s case

9 and Treatment protocols against pain, made on the EBM, homogeneous and accepted in different areas of interest Accreditation path Illustrative material and shared instruments about the project Pain-free hospital and land Department procedures and operating instructions

10 OBJECTIVE : NO PAIN Continuous Co-operation with the regional network Regional Committee Against Pain Positive actions in network Epidemiological surveys health political plan

11 THE STUDY Pain in eligible patients in our hospital. one-day prevalence study, 29th May 2009 Did you feel pain in the last 24 hours? The tool: Pain relief form

12 2009: OUR HOSPITAL University hospital Arcispedale S. Anna 860 beds: - 744: ordinary hospitalization - 116: day hospital/day surgery

13 % Abs. freq SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara F M Age groups and gender Year N of patients The sample Ordinary hospitalization >=18 - <=29 >=30 - <=44 >=45 - <=59 >=60 - <=74 >=75 F M The sample: 681 people age, hospitalization %distribution of age groups, in gengeral and by gender Mean age 2009 F M 64,7 64,9 64, < 15 >=15 <30 >=30 <45 >=45 <60 >=60 <75 >=75

14 Gender Distribution F % M % F M Gender, schooling..

15 % Abs Freq SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara Freq. Distribution by ward and gender ,8 10,0 35,4 31,2 2,8 F % 3,7 Description of the sample: hospitalization/ward and mood. 0 CHIR MED ONCO Distrib. of mood in the last two weeks: 3 levels of mood, by gender 55,9 56,7 F 50 M ,6 14,1 22,5 29, basso (0-3) discret (4-7) buono (8-10)

16 % % % SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara Pain, reason of pain, intensity of pain % presence of pain in the last 24 hours % presence of pain in the last 24 hours, by gender 221; 35% ,8 67,8 F% M% ,2 32, ; 65% 10 0 No Si no si ,9 Distrib by reasons of pain 50, Pain intensity, 4 levels 57,3 27, ,7 7,7 1, ,8 9,7 assente (0) lieve (1-3) moder (4-7) intens (8-10) Interv.chir. Trauma Diagnost. Altro blank 35%: Pain!!

17 SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara Did you use any kind of analgesic drug?

18 Awak MedVis Medic BodNeeds Lunch Relat Aftern Dinner AfterDinn Night Percento Psychological aspect: How do you feel during the different moments of your hospitalization? How do patients feel during different hours of day and night Very bad Bad Normal Good Very good Don't know blank

19 What would you like to feel relief? Presence of loved people 12,7 Feeling less pain 10,9 Not being a burden to the family 10,8 More self-sufficiency 9,9 To be reassured 9,7 Precise informations on care 9,3 Psychological support 5,4 More comfortable place 5,3 Health care at home 5,3 Economic support for therapy Siritual and moral support 4,8 5,1 F% M% To hope strongly 4,5 To give a sense to my suffering 4,2 other 2, %

20 How do you assess the quality of given informations? Adequate 40,5 No answ er 14,5 Very adequate 13,1 Totally adequate 10,3 Didm't receive any information 8,4 Don't know 5,0 Inadequate 4,2 F% M% Very inadequate 2,8 Totally inadequate 1, %

21 % % SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara NO pain' , MALES y = 1,55x R² = 0,377 NO PAIN in the previous surveys (by gender) NO pain ' , FEMALES Females Males ,6% 15,9% ,4% 28,6% 5 y = 1,431x , R² = 0, ,4% 22,5%

22 % % SERVIZIO SANITARIO REGIONALE EMILIA-ROMAGNA Azienda Ospedaliero Universitaria di Ferrara Severe pain' , MALES SEVERE PAIN in the previous surveys (by gender) 10 8 y = -0,544x R² = 0, Severe pain' , FEMALES Females Males ,6% 13,2% ,8% 15,6% y = -0,844x , R² = 0, ,7% 9,9%

23 RESULTS Pain in hospitalized people exists Women feel pain more than men The prevalence of pain in our hospital is 35% The prevalence of pain (NRS> 3 ) is % Pain influences the mood Intensity of pain in both men and women seems to be around a moderate level (NRS 4-7) Suffering patients are satisfied after receiving a medical treatment

24 THE FUTURE The dedicated form Treating pain together

25 The New hospital In CONA

26 Aziena Ospedaliera Universitaria Arcispedale S.Anna Ferrara The common aim, in a network....to work together and not to feel alone t.matarazzo@ospfe.it chiara.borghi@student.unife.it Thanks to : Direzione Strategica Aziendale, Ermes Carlini, COTSD, Beppe Gilli, Roberto Gaiani, Franco Guerzoni, Paola Caponcelli, Annamaria Ferraresi, Brunella Verri, Stefano Bianchi, Rossella Carletti, Referenti Attività Professional, Referenti Medici,..and to all those who believe that the acceptance of pain is ironic, because pain is nonhuman, suffering is touchable, and to hope is more difficult than beleave.