Évaluation du contrôle de la douleur ainsi que de la satisfaction du personnel infirmier et des mères à la suite de l'implantation d'un programme d'automédication en obstétrique

ABSTRACT Background: The Montfort Hospital in Ottawa found that obstetric patients were waiting too long to receive pain relief medications. This represented a significant gap in care. Objectives: To evaluate the implementation of a self-medication program in obstetrics, the degree of pain relief experienced by women using self-medication, and nurses’ and mothers’ satisfaction with the program by means of a survey. Method: In this descriptive study, nurses’ compliance with 12 practice criteria in the self-medication protocol was assessed over a 4-week period (May 30 to June 26, 2005). To determine the extent of patients’ pain relief, the severity of each patient’s pain was measured before and after self-administration of ibuprofen and/or acetaminophen doses, and averages were determined. A 7-question telephone survey was administered to some mothers, and a 3-question written survey was administered to some nurses. Results: One hundred and forty-seven charts were reviewed. One hundred and twenty-eight (87%) of the mothers participated in the self-medication program. After 4 weeks, the mean compliance rate for 10 of the practice criteria was 84%. After 9 days of data collection, important gaps from the selfmedication program were noted, and a memo was sent to the nursing staff to improve on 4 points. Eighty-nine percent (n = 75) of women obtained pain relief from ibuprofen alone, compared to 85% (n = 69) with acetaminophen alone and 87% (n = 49) with both medications. No clinically significant difference was observed between the 2 medications (p = 0.42, t test). Of the 35 mothers and 15 nurses who were surveyed, 94% and 100%, respectively, appreciated the self-medication program. Conclusion: With a mean compliance rate above 80%, this project was considered a success. More than 85% of mothers obtained appropriate relief with the medication offered in the program, which indicates that the empowerment conferred by the self-medication program meets the needs of a high proportion of mothers. RESUME Historique : L’hopital Montfort a Ottawa a mis le doigt sur une lacune importante dans ses soins, soit un delai d’attente trop long avant l’administration de medicaments a sa clientele obstetrique. Objectifs : Evaluer la mise en application d’un programme d’automedication en obstetrique, evaluer le degre de soulagement des femmes par la prise autonome de medicaments, puis evaluer, au moyen d’un sondage, le degre de satisfaction du personnel infirmier et des meres. Methode : Une etude descriptive d’une duree de quatre semaines (du 30 mai au 26 juin 2005) a evalue la conformite de la pratique du personnel infirmier quant a 12 criteres distincts inscrits au protocole d’automedication. Pour determiner le degre de soulagement de la douleur des patientes, nous avons effectue, pour chaque patiente, une compilation des mesures moyennes de l’intensite de la douleur avant et apres la prise de la dose d’ibuprofene et/ou d’acetaminophene. Un sondage telephonique comportant sept questions et un sondage ecrit comportant trois questions ont ete respectivement effectues aupres de certaines meres et infirmieres. Resultats : Cent quarante-sept dossiers medicaux ont ete revises. Cent vingt-huit (87 %) des meres ont participe au Programme d’automedication. Apres quatre semaines, un taux de conformite moyen de 84 % a ete obtenu pour 10 criteres etudies. Apres neuf jours de collecte de donnees, on a note des ecarts importants par rapport au Programme d’automedication, et une note de service a ete envoyee au personnel infirmier afin d’ameliorer quatre points. Quatre-vingt-neuf pour cent (n = 75) des femmes ont obtenu un soulagement avec l’absorption d’ibuprofene seul, contre 85 % (n = 69) avec l’acetaminophene seul, et 87 % (n = 49) avec les deux medicaments combines. Aucune difference cliniquement significative n’a ete detectee entre ces deux medicaments (p = 0,42, test de t). Des 35 meres contactees, 94 % ont apprecie le Programme d’automedication et 100 % des 15 infirmieres ayant repondu au sondage. Conclusion : Le taux de conformite moyen etant superieur a 80 %, ce projet est considere comme une reussite. Plus de 85 % des meres ont obtenu un soulagement approprie avec la medication offerte dans le Programme, ce qui demontre que l’autonomie ainsi accordee repond au besoin d’une forte proportion de meres.

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