Patient-Controlled Analgesia for Sickle Cell Pain Crisis in a Pediatric Emergency Department

Melzer-Lange, Marlene; Walsh‐Kelly, Christine M.; Lea, Gwen; Hillery, Cheryl A.; Scott, John

doi:10.1097/01.pec.0000106235.72265.29

Cited by 48 publications

(37 citation statements)

References 9 publications

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“…Hastaların %5'inde bu rakam 10'a kadar çıkabil-mektedir. [3,13] On bir yılı kapsayan çalışmamızda ebeveynlerin %85.2'si yöntemi ikiden fazla kullanıldığını ifade etmişlerdir.…”

Section: Discussionunclassified

“…[14][15][16] Farklı çalışmalarda iv olarak sürekli infüzyon ve istek dozunun birlikte kullanımı ağrının azaltılmasın-da diğer yöntemlere göre daha etkin olarak saptanmıştır. [2,3,17] Çalışmamızda da kullanıcıların %87.2'si ağrılı krizde ağrının azaltılmasında HKA yöntemini diğer yöntemlere göre daha etkin bulmuştur.…”

Section: Discussionunclassified

“…[1] Hastaların ağrılı krizle acil polikliniklerine başvuru oranları %79-91 olarak bildirilmekte ve bunların %59-68'i yatarak tedavi gerektirmektedir. [2,3] Ağrılar genellikle orta ve ciddi düzeydir. Bu nedenle analjezi için sıklıkla opioid uygulanmasına gereksinim duyulur.…”

Section: Introductionunclassified

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Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

Turaç

Atıcı

2016

Agri

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ÖzetAmaç: Orak hücreli anemi (OHA) tanılı çocukların ağrılı krizlerinde, hasta kontrollü analjezi (HKA) yöntemi ağrı tedavisinde tercih edilen bir yöntemdir. Bu çalışma ile OHA tanılı çocuklarda iv HKA yöntemini uygulayan sağlık personeli ve ebevenlerin, yöntem hakkındaki düşüncelerinin ve ilaç uygulama tutumlarının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Algoloji Bilim Dalı tarafından iv HKA yöntemi uygulanan OHA tanılı çocuk hastaların ebeveynleri (n=54) ve tedavileri ile ilgilenen sağlık personelleri (doktor, hemşire) (n=32) olmak üzere toplam 86 kişi çalışmaya alındı. Yöntemin etkinliğinin değerlendirilmesi için katılımcılara anket uygulandı. Kullanıcıların HKA yöntemi hakkındaki bilgi düzeyleri, avantaj ve dezavantajları hakkındaki görüşleri sorgulandı. Bulgular: Sağlık personellerinin %65.6'sı (n=21) HKA yönteminin "akut dönemde gerekli" olduğunu düşündüğü saptandı. Ağrının gece ve gündüz daha iyi kontrol edildiğini düşünenlerin oranı %93 (n=80) idi. Ebeveynlerin %83.3'ü (n=45) sağlık personelinin %87.5'i (n=28) yöntemin ilaca ulaşamama korkusunu azalttığını belirtmiş idi. Ağrının yeniden başlama korkusundaki azalma sağlık personeline göre ebeveynlerde daha belirgindi (sırasıyla %37, %9.4) (p<0.05). Bağımlılık ve yüksek doz ilaç endişesi nedeniyle ebeveynlerin %87'sinin (n=47) istek dozunu kullanmak için ağrı şiddetinin artmasını beklediği saptandı.Yöntemin dezavantajı olarak en çok alarmların giderilmesi (%48; n=26) ve tekrar doldurma için beklenilen sürenin (%48; n=26) uzunluğu belirtilmiş idi. Sonuç: Çalışmamızda, OHA'li çocukların ağrılı durumlarında iv HKA yönteminin hem sağlık personelleri hem de ebeveynler tarafından etkili bulunduğu saptandı. Bununla birlikte kullanıcıların ilaç hakkındaki yanlı bilgilerinin yeterli analjezi düzeyine ulaşmayı engelleyebileceği fark edildi. Yöntemin etkinliğinin artırılabilmesi için kullanıcı endişelerinin yanıt bulacağı eğitimlerin düzenlenmesinin gerekli olduğu kanısına varıldı.Anahtar sözcükler: Ağrılı kriz; çocuk hasta; hasta kontrollü analjezi; orak hücre anemisi. SummaryObjectives: This study evaluated the efficacy of patient-controlled analgesia (PCA) used by children with sickle cell anemia (SCA) based on the attitudes of parents and healthcare professionals. Methods: A total of 86 individuals were involved in the study: 54 parents of children with SCA who were receiving treatment and 32 healthcare providers (doctors, nurses). To evaluate the effectiveness of the PCA method, a questionnaire was prepared to determine the level of knowledge of the participants about the PCA method and their perception of its advantages and disadvantages. Results: According to 65.6% (n=21) of the healthcare providers, PCA should be used during acute phase of pain. The great majority of the participants (93%; n=80) thought that pain was effectively controlled both during the day and at night. PCA reduced the fear of unavailability of analgesic drugs in 83.3% (n=45) of parents and in 87.5% (n=28) of healthcare providers. More parents (37%) reported a reduction in the fear o...

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Section: Discussionunclassified

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Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

Turaç

Atıcı

2016

Agri

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“…While any undertreatment of pain is not acceptable, this does not appear to explain the high level of parent dissatisfaction. The relatively low level of dissatisfaction with pain treatment may be due to the early transition to patient controlled analgesia at our institution, which has been shown previously to improve satisfaction [6].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study examined parent satisfaction with care for one aspect of treatment and found that the initiation of a morphine patient controlled analgesia protocol decreased time between morphine treatments and improved parent satisfaction when initiated in the emergency department [6]. While this study did not use a validated survey, parent satisfaction surveys are now validated and their use widespread [7,8].…”

Section: Introductionmentioning

confidence: 99%

Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

Brousseau

Mukonje

Brandow

et al. 2009

Pediatric Blood & Cancer

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BackgroundA previous study reported increased dissatisfaction with hospital care for children with sickle cell disease (SCD); however, its small size excluded determining whether race and chronic disease explained the difference.ProcedureAt hospital discharge, parents of children with SCD completed a survey assessing satisfaction with their child's hospital care. Results were compared to three years of satisfaction surveys for children with asthma or admitted to a general pediatrician's service collected as quality improvement for the hospital. The primary outcome was parent reported dissatisfaction with care. A chi‐square was used to compare dissatisfaction between SCD and each comparison group.ResultsParents of 639 children were included, 34 children with SCD, 124 with asthma, and 481 general pediatric patients. Parents of children with SCD were more often dissatisfied with their child's care compared to children with asthma (32.4% vs. 16.9%, P < 0.05) and general pediatric patients (32.4% vs. 14.6%, P < 0.05). Among all children, dissatisfaction was higher in families with minority children (21.1% vs. 12.6%); this difference did not exist among children with asthma. Among African‐American children, a higher proportion of parents of children with SCD believed their child was treated differently because of race than children with asthma (45.5% vs. 2.8%, P < 0.01) or general pediatric patients (45.5% vs. 8.3%, P < 0.01).ConclusionParents of children with SCD report increased dissatisfaction with care. While dissatisfaction was higher in minority families, the high rate of parental concern about race as a reason for families of children with SCD is not seen in African‐American families of children with asthma. Pediatr Blood Cancer 2009;53:174–178. © 2009 Wiley‐Liss, Inc.

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Frequently asked questions by hospitalists managing pain in adults with sickle cell disease

Smith

Jordan

Hassell

2011

Journal of Hospital Medicine

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Pain is the predominant medical presentation to hospitalists for patients with sickle cell disease (SCD). Dramatic treatment gains of SCD in childhood have resulted in more adults now requiring hospitalization than children. This has created new challenges to improve the quality of hospital care for SCD. The evidence base for pain management in SCD is lacking. We therefore offer some evidence and our informed opinion to answer frequently asked questions (FAQs) about pain management by hospitalists caring for adults with SCD. The most common questions center around defining a crisis; selecting and managing opioids; distinguishing between opioid tolerance, physical dependence, and addiction or misuse; determining appropriateness of discharge; and avoiding lengthy or recurrent hospitalizations. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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Patient-Controlled Analgesia for Sickle Cell Pain Crisis in a Pediatric Emergency Department

Abstract: A protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.

Cited by 48 publications

References 9 publications

Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

Frequently asked questions by hospitalists managing pain in adults with sickle cell disease

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