Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient
Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient
Goals
- Administer initial bundle within 60 mins of arrival to the ED with moderate/severe pain
- Offer IN fentanyl for rapid pain relief in moderate/severe pain
- Aggressive titration of analgesics to adequately control pain
- Pain assessment q30min until improving, then hourly
- Increase % discharged home from Emergency Department
- Increase use of adjuncts in pain management
- Thermacare
- Distraction, Child Life, Acupuncture
- Order scheduled opioids if admission required
- Standardized pain management once admitted to an inpatient unit
Metrics
ED
- % received bundle within 60 mins of arrival to ED
- % received IN fentanyl
- % received 2nd IV opioid dose with 45 min of 1st IV opioid dose
- % with improvement in pain score > 1 within 60 min after initial ED bundle
- % with Child Life Consult
- % with Integrative Medicine Acupuncture Consult
- Readmission rates at 7, 14 and 30 days
Inpatient
- Admission rate
- Hospital LOS
- Total amount of parenteral opioid during admission
- % treated with PCA inpatient
- % with inpatient pain plan
- Time to a pain score below pain score of 6, once admitted