2.50
Hdl Handle:
http://hdl.handle.net/10755/162782
Type:
Presentation
Title:
Emergency Department Program for Adult Sickle Cell Patient Pain Management
Abstract:
Emergency Department Program for Adult Sickle Cell Patient Pain Management
Conference Sponsor:Emergency Nurses Association
Conference Year:1998
Author:Finch, Kathleen G., RN
P.I. Institution Name:Duke University Hospital and Health Care System
Contact Address:, Durham, NC, USA
Clinical Topic: The project objective was to provide a system to treat Sickle Cell patients in pain. The need for this project was based on information obtained from patient satisfaction surveys. Patients identified as having high-risk pain management needs included: inconsistent pain management and inappropriate analgesia; slow staff response for pain relief; lack of evaluation of pain control efficacy; increasing time to treatment; and inconsistent evaluation of the crisis events potential for life-threatening outcomes.

Implementation: A patient satisfaction survey was conducted to evaluate improvement efforts along with chart audits to validate time stamps, and a review of ED procedures. A multidisciplinary team (ED, Inpatient and Outpatient) was formed to develop an ED clinical care path for adult Sickle Cell patient management. Individualized care guidelines for initial pain management included patient-specific loading doses and the use of PCA pumps for medication administration. Triage severity was increased to an emergent priority. A medical management algorithm for ED treatment time, observation and admission criteria, and follow-up system was developed. Order sheets and computer orders also were developed. Staff education to gain commitment was supplemented with a video. CQI monitors were established. Patients, admitted or observed were interviewed by a pharmacist to adjust the PCA dosing and to obtain feedback data regarding treatment efficacy. A patient-led support group was used to benchmark improvement.

Outcomes: The patient satisfaction survey indicated: (a) reduced time was spent in the ED before analgesia; (b) reduced time to PCA pump implementation; (c) patients reported improved staff response for providing pain interventions, (d) improved continuity in care; (e) cluster visits were reduced by 20% (more than 3 ED visits/patient/event); (f) reduced hospital admissions; and (g) reduced length of stay.

Recommendations: The ED system developed to manage Sickle Cell patients in pain includes the use of a clinical care pathway, individualized dosing plans, and the use of PCA pumps. The use of clinical care paths, in addition to the exchange of information between inpatient and outpatient areas has improved continuity of ED care, follow-up, and referral. The use of the ED Sickle Cell Pain Management program as a template for the development of treatment systems for other patient populations that use the ED for emergent treatment of exacerbation of chronic disease process is recommended. Principles of pain management, patients' response to analgesia, and use of PCA pumps can be useful for a broader group of ED patients. [Clinical Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleEmergency Department Program for Adult Sickle Cell Patient Pain Managementen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162782-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Emergency Department Program for Adult Sickle Cell Patient Pain Management</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1998</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Finch, Kathleen G., RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Duke University Hospital and Health Care System</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Durham, NC, USA</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: The project objective was to provide a system to treat Sickle Cell patients in pain. The need for this project was based on information obtained from patient satisfaction surveys. Patients identified as having high-risk pain management needs included: inconsistent pain management and inappropriate analgesia; slow staff response for pain relief; lack of evaluation of pain control efficacy; increasing time to treatment; and inconsistent evaluation of the crisis events potential for life-threatening outcomes.<br/><br/>Implementation: A patient satisfaction survey was conducted to evaluate improvement efforts along with chart audits to validate time stamps, and a review of ED procedures. A multidisciplinary team (ED, Inpatient and Outpatient) was formed to develop an ED clinical care path for adult Sickle Cell patient management. Individualized care guidelines for initial pain management included patient-specific loading doses and the use of PCA pumps for medication administration. Triage severity was increased to an emergent priority. A medical management algorithm for ED treatment time, observation and admission criteria, and follow-up system was developed. Order sheets and computer orders also were developed. Staff education to gain commitment was supplemented with a video. CQI monitors were established. Patients, admitted or observed were interviewed by a pharmacist to adjust the PCA dosing and to obtain feedback data regarding treatment efficacy. A patient-led support group was used to benchmark improvement.<br/><br/>Outcomes: The patient satisfaction survey indicated: (a) reduced time was spent in the ED before analgesia; (b) reduced time to PCA pump implementation; (c) patients reported improved staff response for providing pain interventions, (d) improved continuity in care; (e) cluster visits were reduced by 20% (more than 3 ED visits/patient/event); (f) reduced hospital admissions; and (g) reduced length of stay.<br/><br/>Recommendations: The ED system developed to manage Sickle Cell patients in pain includes the use of a clinical care pathway, individualized dosing plans, and the use of PCA pumps. The use of clinical care paths, in addition to the exchange of information between inpatient and outpatient areas has improved continuity of ED care, follow-up, and referral. The use of the ED Sickle Cell Pain Management program as a template for the development of treatment systems for other patient populations that use the ED for emergent treatment of exacerbation of chronic disease process is recommended. Principles of pain management, patients' response to analgesia, and use of PCA pumps can be useful for a broader group of ED patients. [Clinical Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:34:03Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:34:03Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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