Outpatient pain clinic and intranasal fentanyl to improve sickle cell disease outcomes

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 administr...

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Bibliographic Details
Published in:Pediatric blood & cancer 2020-10, Vol.67 (10), p.e28648-n/a
Main Authors: Myrick, Raven, Blakemore, Shaundra, Waite, Emily, Pernell, Brandi, Madan‐Swain, Avi, Hilliard, Lee, Lebensburger, Jeffrey
Format: Article
Language:English
Subjects:
Acute Pain - drug therapy
Acute Pain - etiology
Acute Pain - pathology
Administration, Intranasal
Adolescent
Analgesics, Opioid - administration & dosage
Anemia, Sickle Cell - complications
Child
Emergency medical care
Female
Fentanyl
Fentanyl - administration & dosage
Follow-Up Studies
Hematology
Humans
Intravenous administration
Male
Morphine
Narcotics
Oncology
Opioids
outcomes
Outpatients - statistics & numerical data
Pain
Pain Clinics - statistics & numerical data
Pain Management
Patients
Pediatrics
Prognosis
Prospective Studies
Quality control
Quality Improvement
Sickle cell disease
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Summary: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 
ISSN:1545-5009
1545-5017
DOI:10.1002/pbc.28648