Pain relief and palliative care
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Background to the project
The project falls within the legal background of the Law n.
38 of the 15 March 2010 in particular with the:
 Regional Law 892 of the 20 June 2011
 Regional Law 1512 of the 14 November 2011
 Regional Law 17 of the 28 May 2012
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Previous Legal Framework to Law n.38/10
Decree of the President of the Council of Ministers of
the 29 of November 2001 (D.P.C.M. del 29 Novembre
2001): Health and social Home care, Residential, and
semi-residential care, and hospital funds for home care to
end of life patients define the Basic Level of Care (Livelli
Essenziali di Assistenza (L.E.A.)
 Law 328/2001 and subsequent operational decrees:
Regional guidelines to reach full integration among all
interventions in the home care sector
D.P.C.M. 20°January 2007 Minimal requirements for
the Hospice.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
LAW n. 38 of the 15°March 2010
 All citizens have the right not to suffer unnecessary pain during
their lifetime and at the end of life;
 Pain needs to be trated;
 The end of life period must be included in the care process.
Main idea
a.the dignity and authonomy of the patient must be protected
withoput discriminations;
b.the quality of life must be protected and promoted to the very
end;
c. the patient and their family must be supported through the
health and social care.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net
Regional Law 892/11
Pilot Project – Pain Relief in Acute-Primary Care (Progetto sperimentale Ospedale - Territorio senza
dolore).
Total funding € 82.685
The Marche Region approved a pilot project finalised to create
a structured pathway with the aim to improve pain relief care
both in acute and especially primary settings.
The Regional Law 1512 of the 14 November 2011 and the
Regional Law 17 of the 28 May 2012 support the above project
as well as other projects within the Law n. 38.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
Authors:
Lucia Di Furia
Luigi Nardi
 Alfredo Fogliardi
 Fabio Izzicupo
 Claudio Caputi
 Vincenzo Firetto
 Fulvio Borromei
 Edoardo Berselli
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
Pain relief acute-primary care net – Aim
The project aims to developing a care model which is able to
guarantee, within the hospitals of the Marche Region, both a
systematic and uniform detection of pain by the health
professional involved (ability to methodically detect pain, ability to
understand the level of pain) and consequently, when necessary,
the administration of the appropriate and efficacious analgesic
treatment.
The project aims at improving the quality of life of patients who
need any kind of treatment and who are in pain
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
The re-organisation and systematization of the current offer of
services could guarantee easier access to the current health
services, in particular reinforcing the pool of services for adults
(and children) in the area.
A new organisational model embedded in the area, will be
developed. The level of care will be divided into three
complementary sectors: the reference pain treatment centres
(HUB), the outpatient analgesic treatment centre (SPOKE), and
the GP surgeries.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
On the basis of the Regional Law n. 892 and application 17/2012
the Marche region has formed a Coordinating Group that, among
other duties, is in charge of piloting the Pain Relief in AcutePrimary Care Project.
The Coordinating Group must:
 Develop the new organisational model embedded in the
area. The level of care will be divided into three complementary
sectors: the reference pain treatment centres (HUB), the
outpatient analgesic treatment centre (SPOKE), and the GP
surgeries.
 Empower a designated structure to operate 24 hours a day
to decrease the number of people who inappropriately access
A&E;
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
 Support professional training to consider Pain as one of the
Vital Parameters;
 Standardised the tool to evaluate the intensity of pain.
 Standardised the professional behaviours towards the
evaluation and treatment of pain;
 Include the patient in the care plan, training him to be able
to perform a verbal or written evaluation of pain through the
“Numerical Rating Scale” (NRS);
 Train personnel to prevent under-estimation of pain,
especially for people who suffer of cognitive deterioration;
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
Guarantee
the continuity of
informatization of the processes;
information
and
the
Guarantee flow of information, communication, and
awareness of the correct use of structures and care pathways;
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
Methodology
The project involves a methodological-managed and clinical-care study to be
piloted in a so called “Area Vasta”, a well-defined area, which is representative
of the critical points and the opportunities of our local healthcare system.
Following evaluation of the pilot project, the necessary modifications will be
made, before extending the operating system in the entire regional area.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
Role of The health professionals
The health professionals observe and document the level of pain of the patient,
as the V vital parameter, using a standardised tool, validated to evaluate the
intensity of pain.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Pain relief acute-primary care net- Piloting a new care model
The project gets its realization in controlling pain, which is often
associated to other symptoms. It includes the take-off of
procedure pain management protocols for adults and children
within the hospital.
The need to safeguard both adult and children patients forces the
Region to define a project which will identify an organizational
pathway able to improve pain relief treatment both in acute and
especially in primary care.
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione
Thank you
Dr.ssa Lucia di Furia
Dirigente Medico PF ricerca sanitaria
e biomedica , innovazione e formazione