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Sickle Cell Pain Management in the Emergency Department

LOYOLA UNIVERSITY HEALTH SYSTEM. Loyola University Chicago. Sickle Cell Pain Management in the Emergency Department. B. Probst, MD; J. Williams, RN; D. Speed, RN, MSN; M. Cichon, DO; C. Jackson, MD; M. Pearlman, MS4. Opportunity to Improve: Pain assessment Treatment of pain Disposition.

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Sickle Cell Pain Management in the Emergency Department

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  1. LOYOLA UNIVERSITY HEALTH SYSTEM Loyola University Chicago Sickle Cell Pain Management in the Emergency Department B. Probst, MD; J. Williams, RN; D. Speed, RN, MSN; M. Cichon, DO; C. Jackson, MD; M. Pearlman, MS4

  2. Opportunity to Improve: Pain assessment Treatment of pain Disposition Desired Outcome: Consistent pain assessment & documentation Standardize treatment Expedite timely disposition to home or admission to hospital Sickle cell patients in the ED: small volume, LARGE PROBLEMS

  3. Opportunity Knocks • Subjective nature of pain • Opioid-tolerant patients • Little use of adjunctive agents • Timeliness of assessment and treatment

  4. Solutions Implemented • Convened a multi-disciplinary team • General Medicine, Anesthesia Pain Service, Social Work, ED Physicians & Nurses • Developed and implemented a focused guideline • Educated ED caregivers & patients • Collaborated with General Medicine initiative for inpatient sickle cell management

  5. Progress to Date • Guideline implemented July, 2002 • Minor adjustments made to guideline after feedback from Caregivers • Identified and collected data measures: • Documentation of VAS • Analgesic usage • Adjunct usage • Time-to-treatment • Length-of-stay

  6. Pain Assessment • VAS documentation improved at all time intervals • Reassessment of pain after medication administration is an area that offers an opportunity for improvement

  7. Pain Medications • Use of Dilaudid has increased since guideline implementation • Demerol utilization has decreased

  8. Time to Treatment & LOS • Time to treatment decreased from 80 to 57 minutes • ED length of stay has decreased from 271 minutes to 232 minutes

  9. Adjunctive Effect of Toradol • Patients that received Toradol, in addition to opioid analgesics, were more likely to be discharged home from the ED, than admitted to the hospital

  10. Conclusions • Focused guideline usage has improved care for sickle cell patients in the ED: • Improved pain assessment • Decreased time to treatment & length-of-stay • Decreased demerol usage • Increased discharge to home with toradol adjunct • Sickle Cell Guideline has proven to be a useful resource for physicians managing pain in patients with Sickle Cell disease.

  11. Next Steps • Continue utilization of guideline • Further education of staff on reassessment after pain medications and treatment of pain • Increase utilization of toradol • Refine guideline based on feedback • Ongoing review of compliance to guideline

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