|
-
-
Throughout the
world
-
-
-
-
-
-
-
|
| |
|
| |
 |
| |
Information about the St. Joseph Clinics ASBL
Today the St. Joseph Clinics group together four hospital institutions which in all form a general hospital of 729 acute beds of a uniquely pleasant nature.
These 729 beds comprise the following :
- 280 beds in surgery (Index C)
- 172 beds in internal medicine (Index D)
- 60 beds in medico-surgery (Indices C and D)
- 12 beds in intensive care
- 44 beds in maternity (Index M)
- 77 beds in paediatrics (Index E)
- 48 beds in geriatrics (Index G)
- 6 beds in palliative care (Index Sp)
- 30 beds for psychiatric care
These four hospital sites, all of which take part in the campaign “Towards a pain-free hospital”, are as follows:
Clinique de l'Espérance
447, rue Saint-Nicolas
4420 Saint-Nicolas
Belgium
Phone : (32) (4) 224 91 11
Fax : (32) (4) 224 90 90
|
Clinique Notre-Dame Hermalle
4, rue Basse Hermalle
4681 Hermalle-sous-Argenteau
Belgium
Phone : (32) (4) 374 70 00
Fax : (32) (4) 374 70 02
|
| |
Clinique St-Joseph
75, rue de Hesbaye
4000 Liège
Belgium
Phone : (32) (4) 224 81 11
Fax : (32) (4) 224 87 70
|
Clinique Notre-Dame de Warenne
47, rue de Sélys-Longchamps
4300 Waremme
Belgium
Phone : (32) (19) 33 94 11
Fax : (32) (19) 33 96 55
|
Origin of the campaign "Towards a pain-free hospital"
The campaign “Towards a pain-free hospital” was started on the initiative of Professor Charles H Rapin, doctor in charge of the Geriatric Polyclinic of the Geneva University Hospitals (from 1993) and occupant of the chair of “Ethics and the end of life” at the University Claude-Bernard in Lyons (from 1994).
The pilot hospital for the project is the St. Luc Hospital of the University of Montreal (CHUM), which joined the campaign in 1992. From 1993 the initiative has been sponsored by WHO. The project has grown with the addition of numerous hospitals in France, Spain, Switzerland and now in Belgium. From 1997 Professor Rapin combined all these initiatives into an “International Association Together against Pain” so as to coordinate and stimulate more effectively the experience of each hospital.
Historical perspective: the St. Joseph Clinics and pain
Well before the institutional project began, the St. Joseph Clinics had introduced specialised structures for combating pain:
- for many years anaesthetists had taken responsibility for acute postoperative pain and the pains of childbirth
- for many years also paediatricians had put a lot of effort into reducing pain in children
- In 1992, establishment of a Mobile Team for Palliative Care (multi-sites)
- In 1997, creation of a Pain Centre (for chronic pain)
- In March 1998, creation of a hospital unit for palliative care (on the Hermalle site)
The programme “You and us together against pain” took off in February 1998.
Important lessons
Long term
The institutional project of the St Joseph Clinics is a process of improving quality in the long term. Like any process of improving quality, certain difficulties arose in its implementation. Some improvements have been introduced to ensure a sound basis for the future.
The dangers
This exacting an ambitious project requires one not to choose the easy solution and to identify right away the possible shortcomings :
- The objective is not always to prescribe more but to prescribe better. A better understanding presupposes that the pain should be envisaged in its totality and not merely from a strictly physiological point of view. To prescribe better involves the correct choice of analgesic, its dose and frequency of its administration. It also involves considering non-pharmacological methods (see above).
- A second danger consists in taking refuge behind existing tools without changing current practice, for example:
- having an EVA measure, without having undergone training in sensitivity to pain and training in the use of this measure
- taking refuge behind a therapeutic guide or a theoretical training without reflecting on its professional application
- distributing the leaflet to patients without any accompanying dialogue and without ensuring that the information is understood
- A tool is justified only if it is integrated into the overall practice of treatment.
- Finally a third danger consists in thinking that one can eliminate all pain. Some pains fill the role of a signal for the organ which is sick (e.g. the first sign of appendicitis is pain in the right ilium).
Human Resources
In the present crisis of crisis and shortage affecting medical staff, it is not simple to get staff to undertake a new project. However, a general commitment is made progressively. And for good reason:
- the project is humanly appealing: pain never leaves one indifferent and every carer is a potential patient
- it provides a human dimension to the nursing staff (through dialogue and listening) and it reasserts the value of the profession
- it is new and it motivates
- it has a consensus value between one site and another in the St. Joseph Clinics (through sharing the same professional experience)
- it is a unifying project in spite of different institutional cultures
The resistance of participants is clarified and reduced by listening and by training. It then becomes clear that the project does not involve additional workload, but on the contrary offers methods for improving the daily life of patients and nurses. Sometimes It means spending time to gain time.
Evaluation of the project
Different indicators are used to evaluate the projects:
- the comparison of scores from Day Zero to Day 91 and Day 365
- the analysis of analgesic prescriptions
- and end-of-studies task for student nurses on the impact of the information given to the patients.
By degrees this information will enable one to study the evolution of the global project and if necessary to modify the objectives of the site or the service.
By Day 365 the scores of each service will speak for themselves, in regard both to the overall treatment of pain and to each individual’s objectives.
Financing
Part of the campaign is financed by sponsorship, in particular by pharmaceutical companies. This concerns the exceptional costs such as printing the leaflets and posters, organisation of the inaugural meeting.
Another part, which is more difficult to cost, concerns the investment of time by the various participants in the project. This is financed jointly by the institution and the medical profession. No cost is borne by the patient.
Concretely
As we can see, it is a policy of small steps which count: progress depends both on the patients who have to become partners in the process and on the care-givers who have to integrate new habits and new tools
From there on the medical staff must concentrate their efforts on projects which are feasible, that is those which fall within their general responsibility and take account of the human and financial means available.
For further information
Monsieur Philippe MIERMANS
Directeur de la Clinique de l'Espérance
or with :
Madame Sophie LERUTH, Infirmière Coordinatrice
Docteur Pierre DUQUENNE, Anesthésiste
Les Cliniques Saint-Joseph ASBL - Clinique de l'Espérance
Rue St-Nicolas, 447-449
4420 Saint-Nicolas
Belgium
Phone : (32) (4) 224 9300
Fax : (32) (4) 224 9090
|
| |
| |
Last updated : 01-01-2006
|
