Implementação de um programa de controle da dor em hospital de traumatologia e ortopedia. Relato de caso

CASE REPORT Rev Dor. São Paulo, 2016 apr-jun;17(2):141-4 Implementation of pain control program in a traumatology and orthopedics hospital. Case report Implementação de um programa de controle da dor em hospital de traumatologia e ortopedia. Relato de caso Marcio Curi Rondinelli1, Juliane de Macedo Antunes2, Waleska de Castro Sampaio1, Jamila Ferreira Miranda dos Santos2 DOI 10.5935/1806-0013.20160032 ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the most frequent clinical complaint in daily, ambulatory and hospital practice. Regardless of its cause, it remains undervalued and, as a consequence, without adequate management, resulting in poor control, thus impairing a physical and social rehabilitation proposal. This study aimed at presenting a pain control program and at spreading the real advantages of its implementation. CASE REPORT: This is a descriptive study with experience report of a national reference orthopedic surgical hospital exclusively assisting Single Health System patients. CONCLUSION: This experience and its results encourage the maintenance of the Pain Control Policy and contribute to reference to other health institutions the benefits of implementing similar programs and policies. Keywords: Fifth vital sign, Indicators, Pain control program. RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das mais frequentes queixas clínicas na prática diária, ambulatorial e hospitalar. Independentemente da sua causa, permanece subvalorizada e, consequentemente, sem tratamento adequado, resultando em insucessos no seu controle, prejudicando uma proposta de reabilitação física e social. O objetivo deste estudo foi apresentar o programa de controle da dor e divulgar as reais vantagens de sua implementação. 1. Clínica da Dor do Instituto Nacional de Traumatologia e Ortopedia, Departamento Médico, Janeiro, RJ, Brasil. 2. Clínica da Dor do Instituto Nacional de Traumatologia e Ortopedia, Departamento de Enfermagem, Rio de Janeiro, RJ, Brasil. Submitted in September 02, 2015. Accepted for publication in April 20, 2016. Conflict of interests: none – Sponsoring sources: none. Correspondence to: Avenida Brasil 500 20940-070 Rio de Janeiro, RJ, Brasil. E-mail: © Sociedade Brasileira para o Estudo da Dor RELATO DO CASO: Trata-se de um estudo descritivo com relato de experiência, em um hospital cirúrgico ortopédico, de referência nacional que atende exclusivamente pacientes do sistema único de saúde. CONCLUSÃO: Essa experiência e seus resultados incentivam a manutenção da Política de Controle da Dor e contribuem para referenciar a outras instituições de saúde os benefícios da implementação de programas e políticas semelhantes. Descritores: Indicadores, Programa de controle da dor, Quinto sinal vital. INTRODUCTION Pain has always been part of men’s lives and is a warning sign. Its chronicity negatively impacts human physical and mental health. Currently, it is estimated that patients with postoperative acute pain, or chronic pain, cost billions of reals to the country in working days lost, legal compensations, insurance and therapies1-3. In practice, it is observed that notwithstanding major advances in pain management and therapy, it is still underappreciated and, as a consequence, it is not timely treated resulting in poor control. Pain worsens disabling physical and emotional disorders, regardless if the baseline disease is known or not4. Attention and prompt assistance to painful patients are critical for the health institution, and that is why it is considered the fifth vital sign, together with temperature, heart rate, respiratory rate and blood pressure. Pain clinical characteristic helps directing the etiology. Nociceptive pain is in general due to diffuse tissue injury, with punctual pain manifestations, pressing or in tension. Neuropathic pain, on the other hand, implies nervous fibers involvement and in general has flashing or burning symptoms, in addition to diffuse and imprecise location. It is important to consider that mixed symptoms are frequent, making difficult therapeutic intervention4. The Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO) has implemented a Pain Evaluation and Control Program involving all institution’s health professionals and considering its management a stage as important as curing the disease. Its benefits are evident because pain control decreases joint disorders and muscle hypotrophy, improves cardiorespiratory dynamics, prevents thromboembolic 141 Rev Dor. São Paulo, 2016 apr-jun;17(2):141-4 Rondinelli MC, Antunes JM, Sampaio WC and Santos JF phenomena and autonomic disorders, and improves anxiety and depression. In addition to bringing comfort to patients and to the health team, the program provides early rehabilitation and hospital discharge. For the institution, it makes beds turnover dynamic and decreases legal issues. This study aimed at presenting the pain control program adopted by INTO and at spreading the real advantages of its implementation, in addition to benefits to patients, health team and the institution. EXPERIENCE REPORT This is a descriptive study on an experience report, as from the year 2006, where we tried to describe the road followed by the multiprofessional team to implement the pain control program in a national reference surgical orthopedic hospital exclusively assisting patients of the single health system (SUS). INTO is today the single Brazilian hospital and one of the 18 international hospitals integrating the International Society of Orthopedic Centers (ISOC), which congregates the best existing orthopedic hospitals. It has international certification by the Joint Commission International (JCI/CBA) which has been renewed three times since 2006. INTO has 21 operating rooms, among them one for emergencies and two with satellite live transmission equipment, in addition to 255 hospitalization beds and 48 intensive care and postoperative beds. Program description This is a pain control program with analgesic protocol and routines agreed with other departments of the institution. It consists of pain recording as the fifth vital sign using validated scales for pain evaluation, and indicators helping quality surveillance. It also encompasses ongoing education strategies for INTO professionals. The National Policy of Ongoing Health Education, introduced by the Ministry of Health by means of Ordinance 198, from February 2004, allows for the identification of qualification and development needs of healthcare workers and the building of strategies qualifying health attention and management aiming at generating a positive impact on individual and collective health5,6. Pain intensity scales used by INTO Pain intensity evaluation and recording should include not only oriented individuals, but also neonates, cognitive deficit or sedated patients. So, four scales were used according to patients’ specificities, as follows: Visual analog scale (VAS) Used for oriented and literate patients, w (...truncated)