Outpatient pain clinic and intranasal fentanyl to improve sickle cell disease outcomes.
Acute Pain
/ drug therapy
Administration, Intranasal
Adolescent
Analgesics, Opioid
/ administration & dosage
Anemia, Sickle Cell
/ complications
Child
Female
Fentanyl
/ administration & dosage
Follow-Up Studies
Humans
Male
Outpatients
/ statistics & numerical data
Pain Clinics
/ statistics & numerical data
Pain Management
Prognosis
Prospective Studies
Quality Improvement
fentanyl
outcomes
pain
sickle cell disease
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
12
05
2020
revised:
14
07
2020
accepted:
28
07
2020
pubmed:
17
8
2020
medline:
5
1
2021
entrez:
17
8
2020
Statut:
ppublish
Résumé
Acute pain events are a leading complication for sickle cell patients. In an attempt to improve pain outcomes, we developed an outpatient pain clinic, and included intranasal fentanyl in the opioid emergency department (ED) pain order set. We evaluated admission rates and opioid administration for patients that attended both the outpatient pain clinic and ED within a 3-month period. We recorded the admission rate, IV morphine equivalents, and time from triage for each opioid order and administration from both an outpatient pain clinic and ED visit within a 3-month period for an individual pediatric patient with sickle cell disease. Thirty patients received acute pain management in both settings. We identified a significant reduction in hospital admission when patients received care in the pain clinic as compared to the ED (17% vs 43%, P = .02). Additionally, outpatient pain clinic patients received significantly less IV morphine equivalents than patients received in the ED (5.6 vs 10.6 IV morphine equivalents, P < .0001). In the ED, intranasal fentanyl was administered in a significantly shorter time than patients ordered intravenous opioid (43 vs 75 min, P = .02). The mean time to receiving an opioid in the outpatient pain clinic was 57 min. The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.
Sections du résumé
BACKGROUND
Acute pain events are a leading complication for sickle cell patients. In an attempt to improve pain outcomes, we developed an outpatient pain clinic, and included intranasal fentanyl in the opioid emergency department (ED) pain order set. We evaluated admission rates and opioid administration for patients that attended both the outpatient pain clinic and ED within a 3-month period.
METHODS
We recorded the admission rate, IV morphine equivalents, and time from triage for each opioid order and administration from both an outpatient pain clinic and ED visit within a 3-month period for an individual pediatric patient with sickle cell disease.
RESULTS
Thirty patients received acute pain management in both settings. We identified a significant reduction in hospital admission when patients received care in the pain clinic as compared to the ED (17% vs 43%, P = .02). Additionally, outpatient pain clinic patients received significantly less IV morphine equivalents than patients received in the ED (5.6 vs 10.6 IV morphine equivalents, P < .0001). In the ED, intranasal fentanyl was administered in a significantly shorter time than patients ordered intravenous opioid (43 vs 75 min, P = .02). The mean time to receiving an opioid in the outpatient pain clinic was 57 min.
CONCLUSION
The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.
Substances chimiques
Analgesics, Opioid
0
Fentanyl
UF599785JZ
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28648Subventions
Organisme : NIH HHS
ID : 5K23HL127100
Pays : United States
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Fosdal MB, Wojner-Alexandrov AW. Events of hospitalization among children with sickle cell disease. J Pediatr Nurs. 2007;22(4):342-346.
Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312(10):1033-1048.
Treadwell MJ, Bell M, Leibovich SA, et al. A quality improvement initiative to improve emergency department care for pediatric patients with sickle cell disease. J Clin Outcomes Manag. 2014;21(2):62-70.
Shenoi R, Ma L, Syblik D, Yusuf S. Emergency department crowding and analgesic delay in pediatric sickle cell pain crises. Pediatr Emerg Care. 2011;27(10):911-917.
Kavanagh PL, Sprinz PG, Wolfgang TL, et al. Improving the management of vaso-occlusive episodes in the pediatric emergency department. Pediatrics. 2015;136(4):e1016-e1025.
Brandow AM, Nimmer M, Simmons T, et al. Impact of emergency department care on outcomes of acute pain events in children with sickle cell disease. Am J Hematol. 2016;91(12):1175-1180.
Raphael JL, Kamdar A, Beavers MB, Mahoney DH, Mueller BU. Treatment of uncomplicated vaso-occlusive crises in children with sickle cell disease in a day hospital. Pediatr Blood Cancer. 2008;51(1):82-85.
Lanzkron S, Carroll CP, Hill P, David M, Paul N, Jr, Haywood C. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol. 2015;90(5):376-380.
Molokie RE, Montminy C, Dionisio C, et al. Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit. Am J Emerg Med. 2018;36(1):88-92.
Wright J, Bareford D, Wright C, et al. Day case management of sickle pain: 3 years experience in a UK sickle cell unit. Br J Haematol. 2004;126(6):878-880.
Ezenwa MO, Molokie RE, Wilkie DJ, Suarez ML, Yao Y. Perceived injustice predicts stress and pain in adults with sickle cell disease. Pain Manag Nurs. 2015;16(3):294-306.
Ezenwa MO, Yao Y, Molokie RE, et al. Coping with pain in the face of healthcare injustice in patients with sickle cell disease. J Immigr Minor Health. 2017;19(6):1449-1456.
Barrett MJ, Cronin J, Murphy A, et al. Intranasal fentanyl versus intravenous morphine in the emergency department treatment of severe painful sickle cell crises in children: study protocol for a randomised controlled trial. Trials. 2012;13:74.
Fein DM, Avner JR, Scharbach K, Manwani D, Khine H. Intranasal fentanyl for initial treatment of vaso-occlusive crisis in sickle cell disease. Pediatr Blood Cancer. 2017;64(6):e26332.
Kelly GS, Stewart RW, Strouse JJ, Anders JF. Intranasal fentanyl improves time to analgesic delivery in sickle cell pain crises. Am J Emerg Med. 2018;36(7):1305-1307.
Akinsola B, Hagbom R, Zmitrovich A, et al. Impact of intranasal fentanyl in nurse initiated protocols for sickle cell vaso-occlusive pain episodes in a pediatric emergency department. Am J Hematol. 2018.
De Franceschi L, Mura P, Schweiger V, et al. Fentanyl buccal tablet: a new breakthrough pain medication in early management of severe vaso-occlusive crisis in sickle cell disease. Pain Pract. 2016;16(6):680-687.
Palermo TM, Dudeney J, Santanelli JP, Carletti A, Zempsky WT. Feasibility and acceptability of internet-delivered cognitive behavioral therapy for chronic pain in adolescents with sickle cell disease and their parents. J Pediatr Hematol Oncol. 2018;40(2):122-127.
Agrawal AK, Robertson S, Litwin L, et al. Virtual reality as complementary pain therapy in hospitalized patients with sickle cell disease. Pediatr Blood Cancer. 2019;66(2):e27525.
Palermo TM, Zempsky WT, Dampier CD, et al. iCanCope with Sickle Cell Pain: design of a randomized controlled trial of a smartphone and web-based pain self-management program for youth with sickle cell disease. Contemp Clin Trials. 2018;74:88-96.