A QI Project to Improve Pain Management in Sickle Cell Vaso -Occlusive Crisis

1. A QI Project to Improve Pain Management in Sickle Cell Vaso-Occlusive Crisis Dana LeBlanc, MD, Renee Gardner, MD, Maria Velez, MD, Cori Morrison, MD Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplant LSUHSC/Children’s Hospital of New Orleans

2. Background • Sickle Cell Disease (SCD) affects 70,000 -100,000 Americans • 2,000 infants are born with SCD each year • Pain due to vaso-occlusive crises (VOC) is a leading cause of hospital admission and healthcare cost in pediatric patients with SCD • National Hospital Ambulatory Medical Care Survey • 1999-2007: ~200,000 ED visits/yr for SCD • 78% of visits were for pain • 17% of patients 0-19 yrs of age

3. Background • Lack of consistent healthcare provider education regarding management of these patients often results in delayed or inadequate analgesic administration • Prolongs hospital stays • Leads to patient distrust and dissatisfaction with the medical team

4. Pathogenesis • Nucleotide substitution in the beta globin gene (glutamic acid to valine) allows hemoglobin S polymerize in deoxygenated states

5. Treatment of VOC • IV hydration • Parenteral opioid administration • Morphine or Dilaudid • Patient controlled analgesia (PCA) or on demand boluses • Adjuvant therapies • NSAIDs • Tricyclic antidepressants

6. Objectives • To evaluate and improve physician education, attitudes and comfort level regarding management of SCD VOC • To improve the timeliness of achieving adequate pain control during a VOC • To reduce hospital stay duration, reduce readmission rates, and improve patient satisfaction with VOC management • Ultimately, to improve the overall quality of life of our sickle cell patients

7. Study Design • 3 parts: • Physician Education and Surveys • Patient Surveys • Inpatient Data Analysis

8. Physician Education & Surveys • Educational modules • Grand rounds presentation • Interactive pain management workshop as part of the intern lecture series • Video recorded “refresher” prior to starting Hematology service month • Materials • Preprinted VOC order forms • Pocket cards with pain management guidelines • Pre and post education surveys • Assess resident knowledge and understanding of VOC management • Assess resident attitudes regarding SCD patients and VOC

9. Preprinted Orders for VOC

10. Study Tools

11. Patient Surveys • Will survey patients both prior to and after initiation of physician education • Will assess: • Patient satisfaction with medical care received • Confidence in the medical staff • Patient perception of pain management • Preferred medications • Promptness of administration • Physician attitudes • Patients to be surveyed at routine clinic visits

12. Inpatient Data Analysis • Retrospective chart review of SCD patients admitted for pain crises • Data to be collected: • Number of hospital days • Time until optimal pain control is achieved • Method of narcotic administration and maximum dose required • Adjuvant therapies • Readmission rates • Pre and post survey data will be analyzed

13. Anticipated Results

14. Questions?