Sickle Cell Pain Management During the First 24 Hours of Inpatient Care Compared to the National Heart Lung and Blood Institute Clinical Practice Guidelines for the Emergency Department: A Quality Improvement Project

Abstract This quality improvement project addressed the clinical practice patterns for the first 24 hours of the hospitalized adult for inpatient care in comparison to the established guidelines for the emergency department treatment of sickle cell pain with the NHLBI 2002 and 2013 guidelines in a suburban teaching hospital. The analysis focused on the treatment provided which included information regarding patient assessments, utilizations for intravenous fluids, oxygen administration, the choice of pain medications including opioids, NSAIDS, and other adjuvants. A post hoc retrospective chart review was conducted with data abstraction on the current clinical practice utilized during the inpatient admission which identified deficits that will lead to the creation of a clinical dashboard for ongoing quality improvement and outcome monitoring. This process was guided by the principles of the Dartmouth Clinical Microsystem’s and the 5 P’s: Purpose, Patients, Professionals, Processes, and Patterns for a complete system change. The overall focus for change was intravenous fluids and rates, opioid titration for pain relief, and patient reported desired pain goals