75-441 / Integral care strategy for patients with pain

Spain
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Galician Health Service

Topic

Quality improvement project
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Category
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GOP Description
 
Implementation level
Regional
Clinical settings
All healthcare centers in the Galician Health Service
Objectives
Improve the patient with pain approach in the Galician Health Service in order to achieve optimal pain management for all Galician citizens, thus obtaining “pain free” hospitals.
Improve quality of life of people with pain and their relatives.
Population
All patients which receive healthcare assistance in the Galician Health Service.
All healthcare professionals in the Galician Health Service.
Methods
 
Methodology
2010:
Galician Health Minister’s Institutional Declaration during the Global Day Against Pain.
Background study in the Galician Health Service. Collaboration with scientific societies and experts who deal with pain care.
Bibliographical revision and insight on what is happening in other countries.
Design, publication and distribution of scales and other material.
Pain as a fifth vital sign is implemented in all public hospitals. Pain is registered in the vital signs chart and in the GACELA Management of Care Application 2010-2011. This objective is included in the management contract which is signed by all hospital directors. 50% of all in-patients must have a pain evaluation register in their vital signs chart. Quarterly monitoring and feedback with benchmarking information in hospitals.

2012:
The Galician Commission on the Strategy Against Pain is constituted in 2012 made up of a multidisciplinary group with patient involvement.
Hospital study of children with pain in 2012.
Systematization of chronic non cancer pain care procedure in primary care (multidisciplinary work group with patient involvement) in 2012 and implementation in 2013.
Training plan for healthcare professionals and for patients by means of the Galician School in Public Health for Citizens. Design and elaboration of the “Patient as pain expert” 2012-2013.
Timeframe implementation
Evaluation of pain as a fifth vital sign: 1 year
All other actions are continuous and PDCA is necessary.
Implementation tools available
Legal text of Pain Commission constitution.
Care to patients with pain procedures.
Pain evaluation scales: VAS, numerical scale, facial pain evaluation scale…
Electronic medical record and register of pain in the vital signs chart and in the GACELA Management of Care Application.
Formative actions.
Galician School in Public Health - Website
Other materials: rulers, posters, booklets
Implementation cost
Costs of training health professionals.
Adaptation of computer program GACELA to record pain as a fifth vital sign and characteristics of pain.
Results
 
Method used to measure the results
Availability of pain care procedures which have been approved by hospital management.
Training records of healthcare professionals and patients.
Qualitative and Quantitative audit of implementation.
Records of pain evaluation as fifth vital sign in GACELA and other Special Records. Quarterly monitoring, to make sure that at least 50% of inpatients have a pain evaluation register in their vital signs chart. Quarterly monitoring and feedback with benchmarking information between centers.
Results
Pain as a fifth vital sign register in inpatients in the Galician Health Service in 2011 (14 hospitals): 71.235 patients (32.3% of all inpatients) and in 2012: 152.997 patients (69.8% of all inpatients).
Pain Commission was created.
The pain as a fifth vital sign procedure was implemented in all 14 public hospitals.
Documentation of the Chronic Non Cancer Pain Care Procedure was concluded and systematized.
Formative program of classroom and online activities for health professionals and patients dealing with pain.
Analysis of the results
Quarterly monitoring which includes sending information based on comparative data to hospital managers, quality departments and healthcare professionals.
All centers use systematized procedures with Galician Health Service consensus, which guarantees optimal care.
The project’s success is based on patient and citizen involvement.
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
Healthcare professionals’ opposition to change.
Poor knowledge of information technology makes registering more difficult.
The healthcare professionals’ lack of training in the pain care field.
Describe the strategies used to overcome the barriers (If needed)
Training in pain care and gaining knowledge of the GACELA management of care application in order to record pain evaluation.
Including pain evaluation in the hospital management contracts.
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
Patients, patient organizations and the general public have evaluated the strategy in a positive way, allowing them to participate in all levels of their health management.
Health professionals have evaluated the implementation as a necessity and are satisfied with the work that all are taking on: individuals, scientific societies, professional associations.
Healthcare professionals are satisfied with the informational feedback on actions and achievements which are taking place which allows them to note how the outcomes are a result of their efforts.

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Contact information
 
Name: Mercedes Carreras
Position/function: Subdirector
Department: Quality and Health Safety
Organisation: Galician Health Service
City: Santiago
Country: Spain
Region: Galicia
E-mail: desenvolvemento.seguridade.asistencial@sergas.es
Phone: 34-881540309
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