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Objectives and description
The beginnings of this campaign lie in an original approach made by Prof. C. H. Rapin in Montreal in 1992, with the objective of changing the behaviour both of health professionals and of hospital patients in regard to the relief of all forms of pain.
Initially it was decided to intervene with doctors, nurses and pharmacists, mainly because these professionals have generally inherited a long tradition of knowledge and of attitudes to pain which are now outmoded.
We decided to encourage everyone to question their practices regarding the relief of pain with a view to importance to a therapeutic attitude advocating a more adequate treatment of pain.
There are three key objectives to the campaign: to inform, to make aware, and to train all the medical staff about all forms of pain, so as to make better use of known methods of relief as well as of new methods becoming available, taking account of the most recent clinical research.
Altogether it consists of :
- informing health professionals and patients and making them aware of the existing possibilities for relieving the different types of pain caused by illnesses and treatments
- enabling patients to be partners in the relief of their pain
- reinforcing the training of the different caring professions on the possibilities and methods of good analgesia
Campaign tools
- An information leaflet entitled “Towards a hospital without pain” (this leaflet is distributed to patients on their meal tray)
- A plan of analgesic treatment given to health professionals and a table of equivalents
- A poster reminding patients that they have to talk about their pain to their doctor
- Information “kiosks”: these kiosks are placed at strategic points in the hospital (canteen, waiting room,…). The subjects treated by each of the kiosks are different and deal with various aspects of the treatment of pain, such as “how to measure pain” of “communicate better for the relief of pain”.
Development of the programme in the field
Of the ten pilot sites in Rhône-Alpes/Burgundy, only seven have introduced it to date. These are Hospitals of Annemasse-Bonneville, Aubenas, Chambéry, Vienne, Mâcon, Saint-Luc/Saint-Joseph, Charmettes, Centre Léon-Bérard, val d’Azergues Geriatric hospital, Charpennes Hospital, HCL Home care.
This “field” phase was developed, from 1995 to 1997, thanks to the initial support of Asta Medica, UPSA, then of Theraplix, according to a protocol in five stages common to all the sites:
1. Information sessions to create awareness (presenting the material, explaining the objectives, explaining the methods of evaluating pain in order to improve the analgesia).
2. Audit, phase 1: evaluation of pain in the establishment or service on Day Zero:
- number of patients suffering pain: postoperative, cancerous (according to medical opinion)
- evaluation of the pain (by means of the scale): quantification of the pain
- evaluation of current practice: appraisal and inventory of analgesic treatments on Day Zero for 24 hours.
3. Audit, phase 2 : launching of the campaign to last three months, putting up the posters, giving the brochure to the patients and their families, organising courses and seminars about analgesics, and organising the kiosk with information posters. The idea was to make commonplace the control of pain (3 stages) as proposed by WHO.
4. Audit – phase 3: evaluation of the impact on Day 91, using the same protocol as for Day Zero.
5. Audit – phase 4 : synthesis and appraisal: collation of data and discussion/appraisal in a seminar in the spring.
The evaluation of the effects of the campaign was based on the following indices:
- the amount of consumption of medicines (morphine and buprenorphine) from Day Zero to Day 91
- the number of patients in pain on Day Zero and Day 91
- the development of any difference : opinion of the patients and opinion of the team
Resume of the two evaluations
(N.B. An article was published in Infokara, March 1997, on the evaluation of the campaign at the Hospital of Annemasse-Bonneville)
1. “Towards a hospital without pain” at the Hospital Centre of Chambéry
P.O. Box 1125 - 73011 Chambéry Cedex
Dr. P. BASSET
The originality of this campaign, whose aim is to respond better to the needs of patients in pain, is the systematic approach to the problem of pain in institutional settings. The objective is to make patients, doctors and carers simultaneously aware.
A hospital project involving the medical services, the management of the hospital, the head of the nursing service, the training institute for nurses : the message being that managing pain is the concern of everybody.
The surveys carried out on the patients and the medical staff after three months and then one year after the start of the campaign, as well as the monthly measure of the consumption of morphine, gave a measure of the situation and provided an evaluation of the impact of the campaign.
The results confirm the need to make routine the evaluation of pain by the medical staff. There is a difference of opinion between patients and medical staff in 50% of patients reporting pain. Half of those hospitalised receive analgesic treatment, but 40% of those in pain do not, and 40% of those in pain who are treated have an EVA of between 50 and 100 mm.
The studies carried out in several hospitals of the region give similar results. They confirm the usefulness of the campaign but at the same time show considerable reticence and resistance to the treatment of pain.
2. “Towards a hospital without pain” at the Hospital Centre of Mâcon
A general hospital of 1100 beds
Dr. G. JANIN
Patients reporting pain on Day Zero and Day 365
- Geriatry (480 patients) on Day Zero 56%; on Day 365 38%
- Short stay (354 patients) on Day Zero 46%; on Day 365 36%
Patient receiving analgesics
- Geriatry : on Day Zero 29%; on Day 365 28%
- Short stay : on Day Zero 40%; on Day 365 48%
Pains relieved (short stay) : on Day Zero 21%; on Day 365 41%
Pains not treated (short stay) : on Day Zero 34%; on Day 365 21%
Medicines from:
- Level one : 60 %
- Level 2 : 27 %
- Level 3 : 13 %
The quantity of analgesics increased significantly
Evaluation (short stay) by
Conclusions
The effectiveness of the campaign after one year shows that it must be continued and the objectives made more precise in order to obtain more relief.
Hospitals
Centre Hospitalier d'Aubenas
Phone : (33) 4 75 35 60 60
Fax : (33) 4 75 35 61 40
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Centre Hospitalier de Chambéry
Responsable : Dr Pierre Basset, M.D.
Phone : (33) 4 79 96 50 50
Fax : (33) 4 79 96 56 84
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Centre Hospitalier de Mâcon
Responsable : Dr Gérard Janin, M.D.
Phone : (33) 3 85 20 30 40
Fax : (33) 3 85 20 30 84
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Centre Hospitalier Annemasse-Bonneville
Responsable : Dr Francis Albert, M.D.
Phone : (33) 4 50 97 80 00
Fax : (33) 4 50 87 40 41
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Centre Hospitalier Lucien-Hussel/Vienne
Responsable : Dr Colette Peyrard, M.D.
Phone : (33) 4 74 31 33 33
Télécopieur : (33) 4 74 31 79 21
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Centre Hospitalier Léon-Bérard
Responsable : Dr Paul Rebattu, M.D.
Phone : (33) 4 78 78 28 28
Fax : (33) 4 78 78 27 16
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Hôpital Gériatrique du Val d'Azergues
Responsable : Dr Marylène Filbet, M.D.
Phone : (33) 4 72 54 19 11
Fax : (33) 4 72 54 19 01
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Hospitalisation à domicile (HAD)
Responsable : Dr Eric Dubost, M.D.
Phone : (33) 4 72 27 23 60
Fax : (33) 4 78 08 04 58
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Pour obtenir des informations
Monsieur Jean-Luc Estournel, socio-économiste
Chaire Éthique et Fin de Vie
ECLS
Palais de la Mutualité - 69003 Lyon
France
Phone : (33) 4 72 91 42 25
Fax : (33) 4 72 91 42 25
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Last updated : 01-01-2006
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