Aims Sickle cell disease (SCD) is a lifelong haematological disorder resulting in anaemia and pain crisis. Specialist centres use experienced staff and accredited protocols to manage pain crises in affected children. The main objective of this audit is to identify areas of management of crises which could be improved in line with recommendations set out locally, by the ‘Painful Sickle Cell Crisis Protocol’ and nationally, by the NHS Sickle Cell disease in Childhood Standards and Guidelines for Clinical Care. This may provide useful insight for service improvement and evidence for similar units throughout the UK and Europe. Of particular interest was timing and efficacy of administration of analgesia.
Methods Baseline audit of management of patients presenting to Accident & Emergency (A&E) or the hospital’s haematology day unit (DU) due to acute pain crisis of SCD was conducted. The study cohort was all patients seen at the hospital with a diagnosis of SCD from 1st January 2010 to 31st December 2011. 43 patients met this criteria. Re-audit to be done January 2014.
Results Of the 43 patients registered with the hospital haematology unit, 12 attended the hospital because of pain crises, whilst 31 had no pain crises within the allotted time frame. 5 patients experienced more than one acute pain crisis. Time to administer initial analgesia was 57 ± 37 minutes. Average length of stay in hospital was 4.5 ± 3 days. The most common initial analgesic administered was oral or IV morphine. 14 of the 25 children had tried medication at home prior to presenting.
Conclusions Aspects of the service identified for improvement include: clear documentation of time patient presents, time they are seen by a doctor and time they are given their first analgesia; unequivocal inclusion of a drug kardex in patients notes and consistent use of a pain scoring system.
Recommendations Implementation of a ‘Sickle Cell Pain Crisis Assessment and Management’ form. This would improve consistency of documentation of information relating to pain crises and therefore accuracy of future service monitoring.
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