Journal: Blood advances
The study examined a standardized, nurse-initiated emergency department pain protocol for children and young adults with sickle cell disease presenting with uncomplicated vaso-occlusive crisis.
Design:
- – Single-center pre-/post-intervention study in a quaternary pediatric ED (ages 0–21).
- – Compared outcomes before and after implementation of a protocol using intranasal fentanyl as the initial analgesic.
Key findings:
- – Hospital admissions and inpatient length of stay both decreased after protocol implementation.
- – Median pain scores at ED presentation and at discharge were similar between periods, indicating maintained pain control despite fewer admissions.
- – Time to first analgesic dose significantly improved post-intervention, including the interval from physician order to administration.
- – Use of IV and intranasal analgesia, particularly intranasal fentanyl (used in 61% of post-intervention visits), increased markedly, with a corresponding reduction in oral analgesic use.
- – In a sustainability analysis, high use of intranasal fentanyl and improved time to first dose were maintained over time.
Conclusion:
A standardized, nurse-initiated ED pain protocol for pediatric vaso-occlusive crisis that prioritizes intranasal fentanyl as the initial agent improves timeliness and consistency of analgesia, reduces hospitalization rates and length of stay, and maintains adequate pain control.