G183(P) Clinical management of acute pain in paediatric sickle cell disease (SCD) following the nice guidance (CG143)

• Published in: Archives of disease in childhood 2020-10, Vol.105 (Suppl 1), p.A65-A65
• Main Authors: Huckerby, L, Clubb, R, Leigh, A
• Format: Article
• Language: English
• Subjects: Analgesia; Antiemetics; Emergency medical care; Emergency medical services; Emetics; Feedback; Guidance; Guidelines; Laxatives; Narcotics; Nursing; Opioids; Pain; Pain perception; Patients; Pediatrics; Sickle cell disease
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-rcpch.154

AimsTo assess if children with SCD presenting to our District General Hospital with an acute painful episode are managed in line with NICE guidance.To compare our results with previous audits (2014 and 2016).To use feedback from the multi–disciplinary team (MDT) to develop sustainable interventions to ensure guidance is met.MethodsWe performed a retrospective case note review (n=28) of medical notes. Primary data were collected from June-December 2018 and included all paediatric patients with SCD who presented in pain to the emergency department.ResultsOur findings were presented to the MDT. Our local guideline was amended, with particular focus on the need to prescribe laxatives, anti-emetics and anti-pruritics to patients taking regular opioids, as well as timely pain relief. Feedback from the MDT, and reviewing interventions used by previous audits led us to amend induction for new doctors, emphasising the guideline and key audit findings.Abstract G183(P) Table 1 2018 2016 2014 Pain assessed on presentation using age appropriate score 89% 94% 57% Analgesia offered within 30 minutes of presentation 32% 65% 60% Nursing observations measured at presentation 89% 56% 25% Bolus of strong opioid offered in moderate-severe pain 90% 87% 32% Effectiveness of pain relief assessed every 30 minutes until a satisfactory pain score was achieved 46% 6% 24% Pain score reassessed every 4 hours 91% 13% 38% Laxatives offered to patients on opioids 73% 13% 84% Anti-pruritics and anti-emetics offered to patients on opioids 46% - - ConclusionsClear improvements have been made from previous audits, however, despite this, there was a stark drop in our rates for offering analgesia within 30 minutes. This may reflect the challenges we face in providing rapid interventions in an ever-growing busy emergency department. Studies show that specialist care is superior over generalist care and improves outcomes (Bundy et al. 2016; Evensen et al. 2016). The Sickle Cell Society suggests a Specialist Haemoglobinopathy Team with links to local hospitals could support acute pain services, as well as an individualised care plan for each patient.This audit reinforces the importance of good acute care pathways and consideration should be given to alternative models of emergency care delivery.