|Welcome to the first 2019 Essential Pain Management Newsletter.
In this edition we have a number of indepth reports and updates from EPM around the word. We think this demonstrates the true versatility of EPM, where we are able to deliver the program and content to medical students in the UK, to Spanish speaking anaesthetists in Central and South America and to non physician anaesthetist in central Africa – how amazing can this be!
EPM around the world
Burundi has joined the EPM family! A series of EPM workshops was held in early December 2018, supported by ANZCA, WFSA and ATSARPS (the Burundi anaesthesia society). There were six external instructors: Odry (Benin), Serge (DRC), Anualite (Rwanda), Olive (Rwanda), Jacqui and Wayne Morriss (New Zealand). The local coordinator was Gilles Eloi Rwibuka (President of ATSARPS).
We ran a one-day workshop followed by an instructor workshop and on the third day, the new instructors did a great job teaching two concurrent groups. The workshops were held in Bujumbura, the largest city in Burundi with a total of 78 participants. Participants came from all over Burundi and included nurses, physicians, physicians and non-physician anaesthetists, midwives and a pharmacist. Teaching was in French and Kirundi, the national languages of Burundi. The instructors and participants were all very enthusiastic. Participant feedback was very positive for all of the workshops. Analysis of the pre-course and post-course tests showed an excellent improvement in scores.
In January 2019, two of the newly trained instructors ran another EPM Workshop at Kibuye Hope hospital in the centre of Burundi and there are plans to do an audit of current pain management practices in Burundi and roll-out EPM to other health care facilities.
Carolina Haylock Loor
The EPM program continues to expand in Latin America. Since the first course in 2012 at San Pedro Sula, Honduras, it has exponentially spread to 14 countries of the Latin American region, confirming the potential of EPM as a tool for changing knowledge and practice through Recognize, Assess and Treat pain. The systematized approach taught in this course allows attendees to speak the same language in pain, encourage them to tailor their institutional protocols, overcome different local barriers all for the benefit of our patients. This then helps the region to bridge the existing gap of a lack of, or poor access to pain relief alternatives for moderate to severe pain. And this is a dream progressively becoming true by having more than 130 EPM instructors whom have actively multiplied the courses in their own countries.
For 2019, in February EPM will train 24 Colombian anesthesiologists in Bogota as EPM instructors; have a Latin America EPM instructors Summit in September 2019 at Buenos Aires, during CLASA meeting; and continue to working insistently to introduce EPM Lite courses to undergraduates in medical schools as part of the curricula, which means a lot of work but a worthy job, to plant the good seed in fertile soil.
In 2018, ANZCA successfully applied to the Federal department of Health to fund a pilot project to give anaesthesia and pain medicine trainees the opportunity to deliver pain management training in Aboriginal community controlled health services. The first stage of this project involves running Essential Pain Management (EPM) workshops for interested trainees in a number of locations around Australia. In stage two, trainees complete cultural competency training and then deliver EPM workshops in an Aboriginal community controlled health service. Project outcomes include:
- Increasing the number of health practitioners, including Aboriginal health workers, with the skills to assess and treat chronic pain and train other professionals.
- Fostering interest in pain medicine and anaesthesia careers in Aboriginal and Torres Strait Islander healthcare professionals.
- Creating stronger links between Aboriginal health services and local specialist healthcare providers.
- Improving the management of chronic pain conditions in Aboriginal and Torres Strait Islander patients and improving health outcomes.
The pilot will be evaluated to assess the project’s impact against the intended outcomes detailed above. If successful, it is hoped to offer the program across a larger number of training sites
Essential Pain Management as basic pain education for healthcare workers in Hong Kong
The Essential Pain Management (EPM) workshop was first introduced in Hong Kong in during the 16th World Congress of Anaesthesiologists in 2016. In 2017 with the help of some overseas colleagues we trained our first batch of local EPM instructors, as well as modified the half-day EPM Lite course to suit our local needs. We were allocated resources to run 20 EPM workshops per year in public hospitals. In October 2018 we extended our reach to private sector through collaboration with the Hong Kong Pain Society.
The beauty of EPM is that it brings together participants from different disciplines to learn about the structured RAT approach towards pain. Since 2017, we have trained 80 EPM instructors to teach over 650 local healthcare professionals about RAT. Those trained have included doctors, nurses and allied health professionals (e.g. phyiotherapists, occupational therapists and clinical psychologists).
As noted in other countries, almost all of our local participants felt their undergraduate training in multidisciplinary pain management was inadequate. After the workshop, over 98% of them felt that the EPM content was practical for use in their workplace, and they felt more confident and competent in managing patients with pain.
Last December we piloted the EPM Lite workshop at the Hong Kong Polytechnic University with physiotherapy and occupational therapy undergraduate students, and their feedback was encouraging. We are also looking into creating e-learning platforms for EPM to facilitate participants with different learning needs.
Essential Pain Management (EPM) Pakistan; A new beginning
EPM was introduced in Pakistan in March 2018 by Dr Usman Bashir at a busy tertiary care public sector Hospital (Lahore General Hospital). It was inaugurated by the president of Society of treatment and study of pain (STSP) Professor Khalid Bashir who promised to provide full support to facilitate EPM and its related activities at National level.
A 2nd full EPM was conducted in October 2018 at Shaukat Khanum Memorial Hospital, Lahore where new instructors from widespread geographical areas of the country attended to help spread the cause further. During 2018 local instructors have been running one day EPM courses in their hospitals on various occasions. All the EPM courses in Pakistan have been self funded so far with help of local Hospitals input.
Apart from enthusiastic uptake of EPM by local healthcare professionals and medical staff with almost 60 participants attending each day of courses run so far, one of the key highlights of EPM in Pakistan has been the instructor meetings with specific emphasis on barriers and their solution.
Various Barriers highlighted at the Instructor meetings include: health care worker related barriers, medication barriers, system /organizational barriers, and patient related and cultural barriers. During instructor meetings specific focus has been on SMART (specific, measurable, attainable, relevant, time bound) objectives where trainers from different Hospitals take on one or 2 such objectives to overcome the barriers discussed.
Examples of these objectives and Quality improvement projects proposed and taken up so far include: Development of an Acute Pain team, Post-Surgical Acute Pain management plan to be prescribed by the anaesthetist, Development of post anaesthesia care unit (PACU/recovery) and incorporating Pain management protocols in PACU, New Vitals Charts where pain scores should be incorporated within the chart, STSP to fund uniform vitals charts which include pain scores as well, once agreed by key stakeholders, EPM to be introduce in Undergraduate Curriculum and Nursing curriculum, EPM to be introduced in Induction Day of medical staff. Some of these these targets have already been achieved while work is ongoing on others.
Overall EPM and its related activity has started a positive momentum in Pakistan to improve awareness and treatment of inpatient pain management. One of the reasons for this wider level enthusiasm and uptake is getting eminent Academics and leading Consultants in Anaesthesiology onboard as local instructors. Their role has been pivotal for success of EPM in Pakistan.
Future directions and planning at a national level include networking with the Pakistan Society of Anaesthesia, the Society for Treatment and Study of Pain and the University of Health Sciences.
EPM-UK is gathering increasing momentum. We now have the course embedded in 18 medical schools through a cohort of experienced and enthusiastic tutors around the country. The size of the project is now large enough to need a network of regional leads and we have recently appointed 8 such anaesthetists, based around the UK, to be the local point of contact for EPM-UK.
The regional leads have an active role in teaching themselves but also in encouraging healthcare professionals of all types to use the EPM approach to pain teaching. This has resulted the course being taught by and delivered to, a variety of healthcare professionals, including nurses and physiotherapists. The course is also used for postgraduate junior Doctors, including general practice, medical and surgical trainees, with increased depth of discussion around the case studies.
We have run several Train the Trainers sessions at national pain meetings, to increase familiarity and uptake around the country, with significant success.
One of our regional leads, has recently run an EPM train the Trainers course for intermediate level anaesthetic trainees, with the result that they have improved their own knowledge and understanding of pain, whilst increasing the pool of EPM tutors. Through these regional projects, we are creating a “snowball effect” as EPM teaching and enthusiasm spreads around the UK.
EPM workshops reported in the last six months
Summary acknowledging the programs and instructors involved in reported EPM workshops during the last six months:
Please note, only programs reported using the online tool are acknowledged here.
The online reporting tool is available here. We encourage all instructors to use the easy-to-complete online reporting tool.
EPM resources available
The following resources are available on the EPM website to use during and after courses and in the promotion of EPM.
EPM flyer– The flyer has general information about EPM
EPM reference bookmark (updated) – The bookmark outlines the RAT acronym on one side and has the Faces Pain Scale on the other
EPM promotional videos – The following short videos are available for viewing and promoting EPM
- EPM in Argentina – In this video, instructors and participants at an EPM course in Argentina discuss the EPM program and why it works so well (with English subtitles).
- Alu’s Story – This video follows anaesthetic registrar Alu Kali from Papua New Guinea as he participates in the Essential Pain Management (EPM) courses.
- EPM in PNG – In this video EPM instructors and participants in Papua New Guinea discuss how the program works and why there is a need for such a program in PNG and across the world.
EPM App – The EPM app for both iPhone and Android is available for downloading. Search for <essential pain management> in the App Store or Google play.
EPM workshop material
- 1-day workshop manual – the second edition is now available in both English and French
- 1-day course slide set – the second edition is now available in both English and French
- EPM Lite course manual second edition (updated March 2017)
- EPM Lite course slide set second edition (updated March 2017)
The following course material is available on request to email@example.com
- 1-day course instructor manual
- EPM Lite course instructor manual
- EPM completion certificates
- EPM Pre and post test sheets
- EPM evaluation spreadsheet
The EPM Facebook page regularly has EPM updates and articles of interest, photos and course reports. Please follow, like and encourage EPM participants to take a look at the Essential Pain Management Facebook page.
For a printable copy of this or past newsletters please visit the ANZCA website here.
Collaboration EPM is fortunate to receive ongoing financial support from ANZCA, the ASA, the Ronald Geoffrey Arnott Foundation, WFSA, RACS and the ANZCA Research Foundation
Courses delivered by the EPM UK Working Group have been funded by Association of Anaesthetists of Great Britain and Ireland Foundation and The Royal College of Anaesthetists.
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