[Quality assurance program for pain management after obstetrical perineal injury].
BACKGROUND
A quality insurance program has been set up in order to improve the relief of pain in patients with perineal injury after childbirth.


METHODS
The program has been developed according to the French standards of accreditation. After elaboration of a referential, a first study (103 patients) allowed to evaluate the ongoing practices and to appreciate the pain intensities. After analysis of the results, an action strategy has been elaborated, with a brand new therapeutic standard and a pain-monitoring program for nurses. Six months later, a second study (105 patients) measured the efficiency of the accomplished actions. The statistic analysis used chi2 and Kruskal-Wallis tests and a multivariate analyse (p <0.05).


RESULTS
Several indicators led to conclude to the success of this program: analgesics prescribed systematically and earlier, best observance, larger utilisation of the NSAI, decrease of the analgesics requests, improvement of the satisfaction referred to the relief of pain. The multivariate analyse showed a risk twice as little as in the second study to have a 36th hour VAS score superior to four (p =0.03).


CONCLUSIONS
The apply of this quality insurance program allowed to improve the analgesia after obstetric perineal injuries. A few adaptations are needed, and also more formations of the medical and paramedical staff. The durability of the accomplished actions shall be evaluated in the future.
Urion
L
L
Service d'anesthésie-réanimation, maternité régionale de Nancy, 10, rue Heydenreich, BP 4213, 54042 Nancy cedex, France.
Bayoumeu
F
F
Jandard
C
C
Fontaine
B
B
Bouaziz
H
H
D000328:Adult; D002985:Clinical Protocols; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D005602:France; D006801:Humans; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D009772:Obstetrical Forceps; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology* / Q000451:nursing; D036801:Parturition; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012015:Reference Standards