Date of Completion

5-2-2017

Embargo Period

5-2-2017

Keywords

sickle cell, pain management, protocols, pain crisis, sickle cell disease clinical practice guidelines, evidence-based clinical practice guidelines for the treatment/management of sickle cell pain, sickle cell disease pain management, care of the adult with sickle cell disease, pain management for adults with sickle cell disease, sickle cell disease protocols, pain crisis guidelines for sickle cell disease, sickle cell treatments, quality improvement for sickle cell disease management, and sickle cell practice patterns

Major Advisor

Deborah Dillon McDonald RN, PhD

Associate Advisor

E. Carol Polifroni EdD, NEA-BC, CNE, RN, ANEF

Associate Advisor

Biree Andemariam, MD

Field of Study

Nursing

Degree

Doctor of Nursing Practice

Open Access

Open Access

Abstract

Abstract

This quality improvement project addressed the clinical practice patterns for the first 24 hours of the hospitalized adult for inpatient care in comparison to the established guidelines for the emergency department treatment of sickle cell pain with the NHLBI 2002 and 2013 guidelines in a suburban teaching hospital. The analysis focused on the treatment provided which included information regarding patient assessments, utilizations for intravenous fluids, oxygen administration, the choice of pain medications including opioids, NSAIDS, and other adjuvants. A post hoc retrospective chart review was conducted with data abstraction on the current clinical practice utilized during the inpatient admission which identified deficits that will lead to the creation of a clinical dashboard for ongoing quality improvement and outcome monitoring. This process was guided by the principles of the Dartmouth Clinical Microsystem’s and the 5 P’s: Purpose, Patients, Professionals, Processes, and Patterns for a complete system change. The overall focus for change was intravenous fluids and rates, opioid titration for pain relief, and patient reported desired pain goals.

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