Assessing the Management of Acute Painful Episodes in children and young people with sickle cell disease

Abstract

Objectives . To assess if children and young people with Sickle Cell Disease (SCD) presenting to our busy district general hospital with acute painful episodes are being managed in accordance with NICE guidelines.1 . To compare our results with previous audits performed in 2014, 2016 and 2018. To develop new methods to ensure guidance is met. Methods . A retrospective analysis was performed of patients with SCD presenting to our district general hospital with acute painful episodes between September 2021 and September 2022. The data was compared with previous audit cycles and new interventions were planned and implemented. Results . 29 patients with SCD presented to our paediatric department with acute painful crises between September 2021 and September 2022. There was an improvement in the number of patients being offered analgesia within 30 minutes of arrival, increasing from 32% in 2018 to 86% in 2021-22. 100% of patients with moderate to severe pain were offered a bolus of strong opioid compared to 90% in 2018. Of those who received opioids, 95.5% were prescribed regular paracetamol and ibuprofen compared to 85% in 2018. There was an improvement in blood pressure monitoring at triage from 46% in 2018 to 98% in 2021-22. For patients taking a regular opioid, prescription of laxatives (54.5%), anti-emetics (55.5%), and anti-pruritics (44.4%) had overall worsened since 2018. Pain scores were assessed every 30 minutes until pain relief had been achieved in 21% of patients, compared to 42% in 2018. Of the patients who received strong opioids, 32% had hourly monitoring for the first six hours compared with 92% in 2018. Conclusion . The interventions implemented in 2018 have led to improvements in several domains of the NICE guidance but further progress is required. We look to improve the standard of care given by introducing an electronic prescribing care-set for SCD painful crises to include regular laxatives, anti-emetics and anti-pruritics. We are updating our SCD pain protocol to recommend reassessments of pain at 30-minute intervals in line with NICE guidelines. We are providing local teaching on this and ensuring laminated copies of the new protocol are placed in key areas around the hospital, including the emergency department and paediatric assessment unit. We are delivering teaching to the MDT to highlight the recommended frequency of pain assessments, and that hourly monitoring should take place for the first six hours after a strong opioid has been administered. We will re-audit in 12 months' time to assess progress.