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Master Thesis

Évaluation de l’utilisation d’une pompe à morphine type « Patient-Controlled Analgesia » chez le patient âgé douloureux, présentant un trouble cognitif, en situation palliative, résidant en établissement d’hébergement pour personnes âgées dépendantes : étude descriptive auprès des médecins coordonnateurs des hospitalisations à domicile de Nouvelle-Aquitaine en 2018

Abstract : Introduction: although the use of a morphine pump using the Patient Controlled Analgesia (PCA) model is a practice that has existed for some time now in the management of pain in elderly people with cognitive impairment, in palliative situations, residing in accommodation facilities for the dependent elderly and supported in home care, there has been so far no recommendation to accompany that practice to date. The objective of our study is to question the determinants of a PCA prescription and the application modalities in that population. Method: a multicenter observational study was carried out with the coordinating physicians of the home care program of New Aquitaine, from November 2018 to February 2019 using a self-administered questionnaire. Results: out of the 44 physicians contacted, 22 participated in our study. 81 % of them used PCA in this context on a monthly basis. The prescription was most often performed by the coordinating physician of the home care himself/herself. When the general practitioner prescribed the PCA, he almost always asked the medical opinion of a colleague expert in palliative care. The determinants of this prescription were clinical and technical (ease and safety of use). The preferred route of administration was subcutaneous. Nurses and caregivers were identified as the main administrators of morphine boluses. The prescribing terms of the PCA remained disparate, as did the training surrounding it. Conclusion: our results suggest that PCA use is needed in the afore mentioned patient population and that cognitive impairment is not an obstacle in itself. Research will have to be conducted to supervise and standardize such practices.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02499796
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Caroline Gauthier. Évaluation de l’utilisation d’une pompe à morphine type « Patient-Controlled Analgesia » chez le patient âgé douloureux, présentant un trouble cognitif, en situation palliative, résidant en établissement d’hébergement pour personnes âgées dépendantes : étude descriptive auprès des médecins coordonnateurs des hospitalisations à domicile de Nouvelle-Aquitaine en 2018. Médecine humaine et pathologie. 2019. ⟨dumas-02499796⟩

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