Lien entre la qualité des interventions téléphoniques des infirmières auprès des adultes atteints de cancer et les visites évitables au service des urgences

Dawn Stacey, Lynne Jolicoeur, Katelyn Balchin, Kate Duke, Claire Ludwig, Meg Carley, Lindsay Jibb, Craig Kuziemsky, Suzanne Madore, Lisa Rambout, Jackie Romanick, Michael M. Vickers, Lorraine Martelli

Abstract


Un projet d’amélioration de la qualité a été mené afin de mesurer la qualité des interventions téléphoniques des infirmières auprès des patients présentant des symptômes associés au cancer. Les patients admissibles au projet avaient téléphoné à une infirmière pour signaler des symptômes dans les 4 semaines précédant une visite aux urgences qui n’avait pas requis d’hospitalisation. Les infirmières spécialisées en oncologie qui ont extrait les données évaluaient la pertinence des visites aux urgences et les points à améliorer. Nous avons eu recours à un outil d’analyse de la gestion des symptômes pour analyser la documentation du personnel infirmier. Sur 77 patients, 87 % des visites aux urgences ont eu lieu durant les 4 jours suivant un appel téléphonique justifié par la présence de symptômes (douleur, dyspnée, constipation, diarrhée, nausées ou vomissements, etc.). Dans 91 % des cas, une évaluation téléphonique plus exhaustive ou une consultation dans une clinique de soins d’urgence aurait suffi. Selon la documentation laissée par les infirmières, peu de patients ont été évalués adéquatement (38 %), ont bénéficié d’une révision de la médication traitant leurs symptômes (49 %) ou ont reçu des conseils sur les stratégies de soins autoadministrés (17 %). La qualité de la prise en charge des symptômes effectuée au téléphone par les infirmières laissait à désirer et il aurait fallu trouver des solutions de rechange pour les patients nécessitant une évaluation d’urgence en personne. Ces constats font ressortir des lacunes dans l’utilisation des directives sur la gestion téléphonique des symptômes.


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