The HOSPITAL SIN DOLOR (PAIN-FREE HOSPITAL) Committee. José María Muñoz y Ramón, MD, PhD Comisión HOSPITAL SIN DOLOR

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1 The HOSPITAL SIN DOLOR (PAIN-FREE HOSPITAL) Committee José María Muñoz y Ramón, MD, PhD Comisión HOSPITAL SIN DOLOR 1

2 HISTORY 1964 OPENING OF THE GENERAL HOSPITAL Hospitals General Hospital Children s Hospital Maternity Hospital Hospital for Trauma and Rehab. Cantoblanco Hospital 5 Out-patient specialised facilities, plus Primary Care network 2

3 MADRID - Area 5 Population of reference: 560,000 citizens Free, universal, comprehensive health services 3

4 LA PAZ, MORE THAN A HOSPITAL Fuencarral José Marvá Peña Grande Alcobendas Colmenar H. Cantoblanco

5 45 years of activity 17 buildings = 150,000 m2 6,200 employees > 500 Millions Budget 5

6 Structure BEDS: OPERATING THEATRES: 48 DELIVERY ROOMS: 11 CONSULTATION ROOMS / SURGERIES: (CEPs)) ,9 Distribución de camas del año 2005(%) 4, ,1 36,4 Quirúrgicas Médicas ,3 Obstetricia Intensivos Pediatría médica ,5 Neonatos 0 H. General H. Infantil H. Maternal H. Traumat. H. Cantob. 6

600 500 610 620 624 2006 2005 2004 6,9 Distribución de camas del año 2005(%) 4,8 400 7,1 36,4

7 Human Resources Staff Board of Directors 16 Physicians 886 Non-medical health workers Nurses Physiotherapists 59 Midwives 67 Technicians 231 Nurse aids Non health workers Administrative 663 Lodging and catering 323 Maintenance 130 Supporting staff 530 Other staff 26 Education School of Nursing 9 Trainees 464 Resident Physicians 444 Midwives 20 TOTAL

8 Barriers for pain management in big hospitals like La Paz The size of the hospital and the large number of staff The dispersion of facilities The uneven awareness on the importance of pain and pain relief The limited resources of the Pain Unit 8

dispersion of facilities The uneven awareness on the

9 Quality at the Hospital Universitario La Paz: Clinical Committees are regarded as institutional tools for Total Quality Management Procesos Estratégicos Estrategias de Dirección Planificación objetivos: Plan estratégico Calidad Revisión del Sistema de Calidad Planificación y detección de necesidades Procesos operativos Profesionales sanitarios y Sociedad Gestión de procesos (Coordinadores de Calidad Servicios Supervisoras Calidad Enfermería) Gestión de riesgos (Unidad Funcional de Gestión de Riesgos) Gestión de la Calidad Percibida (Grupo de Mejora de la Calidad Percibida) Constitución y funcionamiento de órganos de gestión de Calidad: - Comisiones Clínicas - Comisión Central de Calidad - Grupo Operativo de Calidad Elaboración de la memoria anual Profesionales sanitarios y Sociedad Procesos de apoyo Plan de Formación en Calidad Gestión administrativa y económica Metodología de Gestión Gestión de los Datos de Carácter Personal Gestión de instalaciones y medios propios 9

de Calidad Servicios Supervisoras Calidad Enfermería) Gestión de riesgos (Unidad Funcional de Gestión de Riesgos) Gestión de la Calidad Percibida (Grupo de Mejora de la Calidad Percibida)

10 HOSPITAL SIN DOLOR Committee MEMBERS Paloma Aparicio Grande, RN Miguel Bernad Pineda, MD AREA / SPECIALTY Pain Unit Sister Rheumatology Jesús Diez Sebastian, MD Biostatistics / Epidemiology Alfredo Fernández Esplá, MD Anaesthesia / Pain Unit Andrés Fernández Prieto, MD Neurorradiology Reyes Figueredo Zalve, MD Anaesthesia / Pain Unit Elena García Higuera, MD Anaesthesia / Pain Unit Pilar Gómez Salcedo, PhD Pharmacy Juan Ignacio González Montalvo, MD Geriatrics Vanesa Guillén Cortijo, RN Intensive Care / PACU Manuel Lara Lara, MD Neurology Ana Mañas Rueda, MD Oncology / Radiotherapy Blanca Martínez Serrano, MD Anaesthesia / Pain Unit Mª del Mar Melo Villaba, RN Paediatric Pain Unit Angela Palao Tarrero, MD Psychiatry José Francisco Paz Solis, MD Neurosurgery Francisco Reinoso Barbero, MD Paediatric Pain Unit Ana Román Guindo, MD Obstetrics & Gynecology Mª Cristina Tena-Dávila Mata, MD Rehabilitation Yolanda Vilches Aguirre, MD Palliative Care Jose Mª Muñoz y Ramón, MD Management 10

Salcedo, PhD Pharmacy Juan Ignacio González Montalvo, MD Geriatrics Vanesa Guillén Cortijo, RN Intensive Care / PACU Manuel Lara Lara, MD Neurology Ana Mañas Rueda, MD Oncology / Radiotherapy Blanca

11 HOSPITAL SIN DOLOR Committee MEMBERS AREA / SPECIALTY Paloma Aparicio Grande, RN 16 doctors from 12 medical specialties, Miguel Bernad Pineda, MD 3 nurses and 1 pharmacist Jesús Diez Sebastian, MD + one member of the hospital direction Alfredo Fernández Esplá, MD Andrés Fernández Prieto, MD Reyes Figueredo Zalve, MD Elena García Higuera, MD Pilar Gómez Salcedo, PhD Juan Ignacio González Montalvo, MD Vanesa Guillén Cortijo, RN Manuel Lara Lara, MD Ana Mañas Rueda, MD Blanca Martínez Serrano, MD Pain Unit Sister Rheumatology Biostatistics / Epidemiology Anaesthesia / Pain Unit Neurorradiology Anaesthesia / Pain Unit Anaesthesia / Pain Unit Pharmacy Geriatrics Intensive Care / PACU Neurology Oncology / Radiotherapy Anaesthesia / Pain Unit Mª del Mar Melo Villaba, RN Paediatric Pain Unit Angela Palao Tarrero, MD Psychiatry José Francisco Paz Solis, MD Neurosurgery Francisco Reinoso Barbero, MD Paediatric Pain Unit Ana Román Guindo, MD Obstetrics & Gynecology Mª Cristina Tena-Dávila Mata, MD Rehabilitation Yolanda Vilches Aguirre, MD Palliative Care Jose Mª Muñoz y Ramón, MD Management 11

Montalvo, MD Vanesa Guillén Cortijo, RN Manuel Lara Lara, MD Ana Mañas Rueda, MD Blanca Martínez Serrano, MD Pain Unit Sister Rheumatology Biostatistics / Epidemiology Anaesthesia / Pain Unit

12 Pain Unit versus Pain Committee One of the goals of Pain Units is to facilitate the awareness and collaboration of all professionals in the process of pain relief. However, their daily overload of clinical duties may limit their activities to the area where they carry out their work. The Pain Committee is active in all areas of the hospital The Pain Unit professionals ARE an important component of the Pain Committee 12

However, their daily overload of clinical duties may limit their activities to the area where they carry

13 Pain Committee methodology of work Monthly meeting Working groups meetings previous to general monthly meeting 13

14 Pain Committee methodology of work 5 working groups: Informative documents: elaboration and distribution of pain-related informative leaflets for patients and health professionals, and customized pain scales for the paediatric and the adult age. Epidemiological studies: periodical surveys of pain prevalence in the different areas of the hospital, of the use of pain scales and compliance with pain protocols. Educational activities: organization and crediting of pain workshops for health professionals, monographic courses and interdisciplinary meetings. Research and publications: organization and participation in epidemiological studies, clinical trials, books, papers and other collaborative projects. External communications: relations with the press, the industry and scientific societies and institutions. 14

Epidemiological studies: periodical surveys of pain prevalence in the different areas of the hospital, of the use of pain scales and compliance with pain protocols.

15 Pain: the 5th vital sign 5,000 pain scales distributed throughout the hospital

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22 EDUCATIONAL ACTIVITIES Weekly interdepartmental meeting Monthly workshops on Acute Pain Course on musculoeskeletal pain Educational rounds Programs for physicians and nurses in training Electives and observerships

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27 Summary & Conclusions The goal of making pain relief a quality objective for the whole hospital has been reached. The Hospital sin Dolor Committee has been formally integrated in the structure of Total Quality Management for the Centre. This methodology of work can be implemented in other institutions Institutional support is mandatory 27

28 Thank you

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