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Objective
The objectives of the campaign are :
- to provide an increase in the rate of relief of pain in hospital patients, according to the medical speciality
- to encourage the adequate taking of analgesics among those suffering from pain, both in hospital and in the community
- to develop the necessary skills among the hospital staff for applying conventional and new methods of relieving pain
- to make the wider public more aware of the many prejudices relating to the relief of pain
Description
The campaign was launched in December 1992 by a group of professionals, nurses, doctors, research workers and pharmacists at the St. Luc Hospital, a general university hospital with 807 beds situated in the centre of Montreal. The general management of hospital as well as its bio-ethical committee supported the project from the start. Moreover the Pan-American Division of the WHO sponsored the campaign from January 1993.
The campaign is aimed at all staff, whether doctors, nurses or pharmacists, and at patients and their families, in order that they become partners of the professionals when it comes to relieving pain. The campaign is also aimed at the general public so as to shatter the myths about the use of analgesics and of narcotics in particular.
One of the first activities of the campaign was to prepare information material. A leaflet was sent to patients and their families. It provides all the information necessary to encourage hospital patients to become effective partners of the medical team in the relief of their pain. Other more specialised documents are also available (see under “Information material”).
The launching of the campaign began by creating information stands at various key locations in the hospital. The subjects treated were varied and dealt with different aspects of treating pain:
- “How to measure pain”
- “Better communication for relieving pain”
- “What will relieve pain as much as 10 mg of morphine SC or IM”
- “Post-operative pain: future solutions”
- “Have you any prejudices regarding pain or analgesics?”
- “Who suffers the more… men or women?”
- etc.
Various lectures were given to supplement the campaign. These were intended primarily for medical staff, but there was at least one a year for the general public. Here are some of the subjects discussed:
- Relief of pain at the terminal stage
- Ethics and the relief of pain
- Chronic pain in old people
- Relief of pain in oncology
- Several topics on the theme of PCA and epidurals, etc.
A colloquium was also organised on the theme of “Ethics and pain” so as to enable doctors and nurses to understand better the different ethical problems which may appear in situations of conflict when the best solution is not necessarily evident to everybody.
After the colloquium, three discussion meetings considered euthanasia and the relief of pain at the terminal stage in the light of particular situations which had been experienced.
Two full days of training were given to about 550 nurses between 1991 and 1996. About 40 auxiliary nurses were also trained.
In 1994, PCA pumps and analgesic by epidural were also made available for surgical patients and training was given to the nurses as well as a follow-up over several months.
In 1994 and later in 1996 a team for palliative care was created to provide better relief of pain and other symptoms at the end of life.
In order to measure the effects of the campaign, every year in May a check was made on the quality of care for the relief of pain. We used and translated into French the questionnaire on quality developed by the American Pain Society. Initially it was applied globally and later by different units and lastly by medical speciality. Between 5 and 7 trainee nurses applied the questionnaire over a period of 3 ½ weeks. Subsequently they presented the results to the units and discussed with the medical staff the various results and the changes to be made. Every year the global results are presented to the medical staff as lectures, workshops or as poster sessions inside and outside the hospital. The weakest elements for all the care units are submitted to two other quality controls during the year and any correctives are applied.
Information material
General public
- Leaflet “St. Luc, a hospital without pain”
Patient and his or her family
- Teaching document for the patient “Self-analgesia controlled by the client (ACP) 1995”
- Teaching document for the patient “To relieve pain – the epidural 1995”
- Teaching cards – Distraction (8 cards) 1990
- Teaching cards – Relaxation (10 cards) 1990
Medical or hospital staff
- Pro forma in the file – Evaluation of pain and the effect of analgesics 1991
- Pro forma in the file – Analgesia controlled by the patient 1994
- Table of analgesic equivalents – French translation of the Agency for Health Care Policy and Research on acute pain 1994
- Care techniques 5.3 – Analgesia controlled by the patient 1994
- Care plan type 1. ? – Acute pain
- Care plan type 1.? – Chronic pain
- Care plan type 9.2 – Use of an epidural catheter for anaesthesia
- Epidural
Results from the hospital
- Results of studies made between 1992 and 1996 on pain relief in the different parts of the hospital
N.B. Some of these documents are free. Others are for sale and Canadian tax of 7% has to be added.
For further information :
Madame Gisèle Besner, M. Sc. inf.
Conseillère en soins spécialisés
Centre hospitalier de l'Université de Montréal (CHUM)
Hôpital Saint-Luc
Direction des soins infirmiers
1058, rue Saint-Denis
Montréal (Québec)
Canada H2X 3J4
Phone : (514) 281.3255, poste 5945
Fax : (514) 281.2228
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Last updated : 01-01-2006
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