2.50
Hdl Handle:
http://hdl.handle.net/10755/344173
Category:
Abstract
Type:
Poster
Title:
Improved sickle cell pain management in the Pediatric Emergency Room
Author(s):
Miner, Renee; Moses, James; Sprinz, Philippa; Killius, Kelly; Sobota, Amy; Dorfman, David; Cunningham, Pearl; Wolfgang, Tahlia; Kavanagh, Patricia
Author Details:
Renee Miner, BSN, RN, CPEN, reminer@msn.com; James Moses, MD, MPH; Philippa Sprinz, MD, MSc; Kelly Killius, PharmD, BCPS; Amy Sobota, MD, MPH; David Dorfman, MD; Pearl Cunningham, MBA, BSN, RN; Tahlia Wolfgang, MPH, BS; Patricia Kavanagh, MD
Abstract:
Evidence-based Practice Abstract Purpose: Many children with sickle cell disease experience severe vaso-occlusive episodes requiring treatment with parenteral opioids. After interviewing patients and parents at our institution and reviewing the literature, timely management of vaso-occlusive episodes in the pediatric emergency department is a significant challenge. The purpose of this study was to provide first opioid medication for vaso-occlusive episodes within 30 minutes of triage and streamline vaso-occlusive episodes management using quality improvement methods. Design: Quality improvement initiative. Setting: Pediatric emergency department in an urban safety net hospital with 28,000 visits/year. Participants/Subjects: Children with sickle cell disease ages 0-21 years presenting with an uncomplicated vaso-occlusive episode. This study was reviewed and was approved as an expedited protocol. Methods: A multidisciplinary team was formed, consisting of representatives from pediatric emergency department nursing, pharmacy, and physicians; hematology social work and physicians; a quality improvement advisor; and families affected by sickle cell disease. We used Plan-Do-Study-Act cycles to improve time to first opioid pain medication (intravenous or intranasal) for vaso-occlusive episodes (primary outcome). Secondary metrics were: a) administration of 2nd IV opioid medication ≤1 hour of triage, and b) decisions to initiate patient-controlled analgesia and inpatient admission ≤2 hours. Our initial interventions included: 1) time-directed checklist, including patient-controlled analgesia and admission decisions; 2) intranasal fentanyl as first opioid medication; and 3) a pain medication calculator, providing doses for all routes of pain medications, including oral. To further streamline care, we instituted a protocol of two intranasal fentanyl doses followed by two intravenous opioid doses within 1 hour of triage. We modified the checklist to skip intravenous doses and transition to oral pain medications if pain decreased to mild or moderate after intranasal fentanyl doses; this was most commonly done for children <2 years of age. Venous access was an issue in adolescent patents, therefore, an infrared device to assist in venous access was purchased for the unit. Registration was expedited for these patients to provide rapid access to pain medications in the Pyxis. We engaged in regular communication with the pediatric emergency department staff, both nursing and physicians, to improve engagement in this project. Results/Outcomes: From September 2010 to November 2013, time to first opioid medication improved from 46 to 22 minutes. Time to 2nd IV opioid dose fell from 102 to 85 minutes, and time to PCA improved from 265 minutes to 150 minutes. Time to admission request decreased from 163 to 117 minutes. We also found that the nursing process and approach to patient care changed as it became easier to provide excellent care for these patients as treatments and protocols were standardized. Implications: Using standard quality improvement methods, we successfully streamlined pediatric emergency department care of vaso-occlusive episodes for children with sickle cell disease. Similar strategies could streamline management of vaso-occlusive episodes for both children and adults nationally.
Keywords:
Pediatric Sickle Cell Pain Management; Pediatric Sickle Cell
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleImproved sickle cell pain management in the Pediatric Emergency Roomen_GB
dc.contributor.authorMiner, Reneeen_GB
dc.contributor.authorMoses, Jamesen_GB
dc.contributor.authorSprinz, Philippaen_GB
dc.contributor.authorKillius, Kellyen_GB
dc.contributor.authorSobota, Amyen_GB
dc.contributor.authorDorfman, Daviden_GB
dc.contributor.authorCunningham, Pearlen_GB
dc.contributor.authorWolfgang, Tahliaen_GB
dc.contributor.authorKavanagh, Patriciaen_GB
dc.author.detailsRenee Miner, BSN, RN, CPEN, reminer@msn.com; James Moses, MD, MPH; Philippa Sprinz, MD, MSc; Kelly Killius, PharmD, BCPS; Amy Sobota, MD, MPH; David Dorfman, MD; Pearl Cunningham, MBA, BSN, RN; Tahlia Wolfgang, MPH, BS; Patricia Kavanagh, MDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344173-
dc.description.abstractEvidence-based Practice Abstract Purpose: Many children with sickle cell disease experience severe vaso-occlusive episodes requiring treatment with parenteral opioids. After interviewing patients and parents at our institution and reviewing the literature, timely management of vaso-occlusive episodes in the pediatric emergency department is a significant challenge. The purpose of this study was to provide first opioid medication for vaso-occlusive episodes within 30 minutes of triage and streamline vaso-occlusive episodes management using quality improvement methods. Design: Quality improvement initiative. Setting: Pediatric emergency department in an urban safety net hospital with 28,000 visits/year. Participants/Subjects: Children with sickle cell disease ages 0-21 years presenting with an uncomplicated vaso-occlusive episode. This study was reviewed and was approved as an expedited protocol. Methods: A multidisciplinary team was formed, consisting of representatives from pediatric emergency department nursing, pharmacy, and physicians; hematology social work and physicians; a quality improvement advisor; and families affected by sickle cell disease. We used Plan-Do-Study-Act cycles to improve time to first opioid pain medication (intravenous or intranasal) for vaso-occlusive episodes (primary outcome). Secondary metrics were: a) administration of 2nd IV opioid medication ≤1 hour of triage, and b) decisions to initiate patient-controlled analgesia and inpatient admission ≤2 hours. Our initial interventions included: 1) time-directed checklist, including patient-controlled analgesia and admission decisions; 2) intranasal fentanyl as first opioid medication; and 3) a pain medication calculator, providing doses for all routes of pain medications, including oral. To further streamline care, we instituted a protocol of two intranasal fentanyl doses followed by two intravenous opioid doses within 1 hour of triage. We modified the checklist to skip intravenous doses and transition to oral pain medications if pain decreased to mild or moderate after intranasal fentanyl doses; this was most commonly done for children <2 years of age. Venous access was an issue in adolescent patents, therefore, an infrared device to assist in venous access was purchased for the unit. Registration was expedited for these patients to provide rapid access to pain medications in the Pyxis. We engaged in regular communication with the pediatric emergency department staff, both nursing and physicians, to improve engagement in this project. Results/Outcomes: From September 2010 to November 2013, time to first opioid medication improved from 46 to 22 minutes. Time to 2nd IV opioid dose fell from 102 to 85 minutes, and time to PCA improved from 265 minutes to 150 minutes. Time to admission request decreased from 163 to 117 minutes. We also found that the nursing process and approach to patient care changed as it became easier to provide excellent care for these patients as treatments and protocols were standardized. Implications: Using standard quality improvement methods, we successfully streamlined pediatric emergency department care of vaso-occlusive episodes for children with sickle cell disease. Similar strategies could streamline management of vaso-occlusive episodes for both children and adults nationally.en_GB
dc.subjectPediatric Sickle Cell Pain Managementen_GB
dc.subjectPediatric Sickle Cellen_GB
dc.date.available2015-02-04T11:27:47Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:47Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.