6699 Sickle cell disease: managing acute painful episodes in hospital
Iverene Tung
Abstract
<h3>Objectives</h3> To review the management of paediatric patients presenting with acute painful sickle cell crisis against NICE guidelines<sup>1</sup> and local guidelines of Royal Bolton Hospital.<sup>2</sup> <h3>Methods</h3> Retrospective data collection from clinical notes between 01/05/2019 to 01/05/2023 and review of data against NICE<sup>1</sup> and local guidelines of Royal Bolton Hospital<sup>2</sup> for the acute management of sickle cell crisis in children using a locally created data collection proforma. 1. Inclusion criteria: Paediatric patients <age 16 or ≥16years but still under the care of local paediatricians Known diagnosis of sickle cell disease Diagnosed with ‘Sickle Cell Anaemia with Crisis’ Managed locally on the paediatric inpatient/observation & assessment unit. 2. Exclusion criteria: Age ≥ 16 years and no longer under the care of local paediatrician No diagnosis of Sickle Cell Disease Alternative diagnosis to sickle cell crisis Managed out of the local paediatric inpatient/observation & assessment unit. <h3>Results</h3> There were 16 patients with a total of 33 presentations combined to Royal Bolton Hospital between 01/05/2019 to 01/05/2023. 3 presentations were wrongly coded and thus did not meet inconclusion criteria. Initial Presentation Out of 30 presentations, 5 were respiratory, 5 were gastrointestinal, 6 were musculoskeletal and 14 were combinations between the systems. All 30 presentations had a complete observation taken at triage and 26 presentations had a pain score recorded at presentation. Pain 67% of presentations were offered analgesia within 30 minutes. Only 37% of presentations received a pain review 30 minutes after initial analgesia and 30% were pain free within an hour. 90% of presentations received paracetamol and/or ibuprofen at the correct dosing. 80% of presentations required opiates, however a low percentage of 10–30% had naloxone, laxatives or anti-emetics prescribed alongside. Antibiotics 67% of presentations received IV Ceftriaxone with only 30% of them receiving the antibiotics within an hour due to delay in assessment, prescribing or administration. Intravenous Fluids 87% of presentations received 120% of intravenous maintenance fluids, with only half having strict fluid input and output monitoring. Investigations Only 20% of presentations had all required investigations completed. Common missed investigations included lactate dehydrogenase, amylase, group and save. <h3>Conclusion</h3> Children are presenting with a variety of symptoms associated with acute painful crisis. From this audit, there is space for improvement in the care provided to these patients in all aspects. Recommendations for improvement include using the local guidelines available when managing patients, teaching sessions to improve awareness of both nursing and medical staff and to re-audit in 4 years after these implementations. <h3>References</h3> NICE (2012) Sickle Cell Disease: Managing acute painful episodes in hospital. clinical guideline [cg 143] published 27/06/2012. G Bowling, J McViety. Local guideline: acute management of sickle cell disease complications in children. April 2020.