Sickle cell pain management in the emergency department: A two phase quality improvement project

This quality improvement project addressed the gaps in sickle cell pain management at a suburban teaching hospital emergency department. The aims were to: (1) measure baseline pain management practices for patients with sickle cell disease, (2) develop and pilot a questionnaire on knowledge, attitudes and self-reported practice patterns for emergency department nurses, (3) provide a continuing education intervention for emergency department nurses aimed at increasing their overall knowledge and optimizing analgesic and holistic management practices for patients with SCD, and (4) implement an adapted Emergency Department sickle cell pain management clinical pathway. A retrospective chart review was conducted for data abstraction on pain management practices. ED nurses completed a pre and post education questionnaire measuring knowledge attitude and self-reported practice on SCD pain management. The nurse education consisted of the unique characteristics of sickle cell pain such as organ damage, need for timely and adequate pain management as well as the application of Levin\u27s principles of conservation to provide holistic care while preserving vital organs. There was significant learning between the pre and post education questionnaire. Medical record review from 44 patient visits showed a high use of monotherapy, delay in time to medical evaluation, medication order, and time to first and subsequent analgesic and pain reassessments. Results were used by a multidisciplinary team to develop and implement an evidence based clinical pathway to improve SCD pain management.