Clinical practice guideline improves the treatment of sickle cell disease vasoocclusive pain

Morrissey, Lisa; Shea, Joan O'Brien; Kalish, Leslie A.; Weiner, Debra L.; Branowicki, Patricia A.; Heeney, Matthew M.

doi:10.1002/pbc.21847

Cited by 36 publications

(29 citation statements)

References 4 publications

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“…8 Despite these recommendations, studies of children with SCD presenting to the ED for VOE management have reported wait times of 65 to 90 minutes for the first dose of parenteral analgesia. [9][10][11] These findings are supported by a qualitative study of adolescents with SCD and parents of children with SCD, who reported delays Drs Kavanagh and Moses conceptualized and designed the study; were involved in the design, revision, and implementation of the interventions; performed data analyses; and drafted the initial manuscript and its revision. Ms Wolfgang assisted in the design and revisions of the interventions used; performed data collection and data analyses; and contributed to the final manuscript.…”

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confidence: 63%

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Improving the Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department

et al. 2015

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OBJECTIVES: Vaso-occlusive episodes (VOEs) account for the majority of emergency department (ED) visits for children with sickle cell disease (SCD). We hypothesized that addressing key barriers to VOE care would improve receipt of analgesics and outcomes.METHODS: A quality improvement (QI) initiative was conducted from September 2010 to April 2014 to streamline VOE care in an urban pediatric ED. Four interventions were used: a standardized time-specific VOE protocol; intranasal fentanyl as the first parenteral pain medication; an SCD pain medication calculator; and provider and patient/family education. Data were collected for 3 outcome measures (mean time from triage to first parenteral opioid and admission/discharge decision, and proportion discharged from the ED); 1 process measure (mean time from triage to initiation of patient-controlled analgesia); and 4 balancing measures (mean time from triage to second intravenous opioid dose, 24-hour ED readmission, respiratory depression, and length of stay).RESULTS: There were 289 ED visits in the study period. Improvements were seen in mean time to: first dose of parenteral opioid (56 to 23 minutes); second opiate intravenous dose (106 to 83 minutes); admission and discharge decisions (163 to 109 minutes and 271 to 178 minutes, respectively); and initiation of patientcontrolled analgesia (216 to 141 minutes). The proportion discharged from the ED increased from 32% to 48% (x 2 = 6.5402, P = .01). No increase in 24-hour readmission, respiratory depression, or inpatient length of stay was observed.CONCLUSIONS: Using VOE-specific interventions, we significantly improved VOE care for children. Studies are needed to determine if these results can be replicated.

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confidence: 63%

“…10,25 However, in these studies, the timeliness of parenteral pain management did not meet recommendations by national experts (eg, first parenteral analgesic in #30 minutes). [6][7][8] A key difference in our study was the focus on explicitly defining the care steps and time goals for the entire ED visit.…”

Section: Discussionmentioning

confidence: 99%

Improving the Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department

et al. 2015

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“…This endpoint is difficult to evaluate because the determination to transfuse is not standardized and takes multiple factors into consideration. Two other studies, one at Children's Hospital in Boston 14 At Children's Hospital in Boston, a significantly reduced time to first analgesia was shown. 14 Results of our study and the growing body of literature on care pathways demonstrates that the influence on physician choices can lead to increased evidence-based practice.…”

Section: Discussionmentioning

confidence: 93%

Hospitalist Management of Vaso-Occlusive Pain Crisis in Patients With Sickle Cell Disease Using a Pathway of Care

Liles¹,

Kirsch

Gilchrist

et al. 2014

Hospital Practice

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“…A post-operative pain management algorithm should be adapted from the patient's usual pain management plan, taking into account the individual's baseline narcotic requirements [36][37][38]. Indeed, incorporation of specific guidelines to aid physicians in the appropriate treatment of pain related to SCD have been shown to significantly improve the delivery of effective pain management in a timely fashion and decrease the need for hospitalization [39]. Since IVF clinics in free-standing ambulatory settings are not used to caring for such patients, it is important that the clinical team be prepared with an appropriate pain management algorithm prior to beginning the cycle.…”

Section: Discussionmentioning

confidence: 99%

Oocyte cryopreservation in a patient with sickle cell disease prior to hematopoietic stem cell transplantation: first report

Dovey

Krishnamurti

Sanfilippo

et al. 2012

J Assist Reprod Genet

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Purpose To report the first occurrence of successful ovarian stimulation, oocyte retrieval and oocyte cryopreservation for fertility preservation in an adolescent with severe sickle cell disease scheduled to undergo a hematopoietic stem cell transplant Methods Case report Results A 19 year old female with severe sickle cell disease presented for fertility preservation counseling prior to hematopoietic stem cell transplantation. She ultimately underwent ovarian stimulation using a minimal stimulation GnRH antagonist protocol resulting in the successful banking of oocytes prior to transplant. The unique hazards associated with ovarian stimulation in patients with sickle cell disease, such as thrombosis and vaso-occlusive events, are discussed and the methods undertaken to minimize these risks are described. Conclusions Controlled ovarian hyperstimulation and oocyte banking for fertility preservation is feasible in young women with sickle cell disease requiring hematopoietic stem cell transplant and deserves further investigation. Given the elevated risk of thrombosis and predisposition to painful vaso-occlusive events, controlled ovarian hyperstimulation in patients with sickle cell disease is not straightforward and requires a multi-disciplinary team approach to adequately address and minimize the risks in this unique patient population.

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Clinical practice guideline improves the treatment of sickle cell disease vasoocclusive pain

Abstract: Implementation of a CPG to manage acute sickle cell pain in the ED improves the ability to deliver timely, effective analgesia to this patient population. Establishing and monitoring internal benchmarks provides a means for ongoing evaluation of the pre-established goals for patient care.

Cited by 36 publications

References 4 publications

Improving the Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department

Improving the Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department

Hospitalist Management of Vaso-Occlusive Pain Crisis in Patients With Sickle Cell Disease Using a Pathway of Care

Oocyte cryopreservation in a patient with sickle cell disease prior to hematopoietic stem cell transplantation: first report

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