A Nurse-Led Education Intervention to Improve Infusion Center Management of Sickle Cell Pain

Abstract

Problem Statement: Patients with Sickle Cell Disease (SCD) experience acute pain episodes for which they seek care in the Emergency Department (ED). SCD predominantly affects African Americans, and adults with SCD face significant disparities and bias when seeking care in the ED (Haywood, et al., 2013; Mills, et al. 2011). In January 2019, the UCSD Sickle Cell team established a same-day infusion center (IC) management strategy for SCD pain crises as an alternative strategy to seeking care in the ED. This program was well accepted by patients, and as the IC volume of sickle cell patient visits grew (270 visits in the two years pre-IC vs.1076 visits in two years post-IC), a need was identified to assess and improve IC staff knowledge and comfort of management of sickle cell pain. Methods: A 30-minute educational presentation (EP) was created and delivered in a hybrid (in-person/virtual) format to IC staff at three IC sites. A 9-question Google Forms survey was created with input from a validated survey tool and administered. This form comprised of 7 knowledge questions and 2 questions related to comfort levels assessing pain and administering pain interventions in persons with SCD. Responses were collected pre- and post-EP at 1-week (0-7 days). Results: Forty-three pre-surveys were recorded, and twenty-two post-surveys were returned. The overall average score of correct knowledge-based questions (7 total) increased from 2.98 to 5.18. The total responses of "Comfortable" and "Very comfortable" increased for both comfort level assessing pain in persons with SCD (40.4% pre-EP to 86.4% post-EP), and comfort level administering pain interventions in persons with SCD (47.5% pre-EP to 91% post-EP). Conclusion: Surveys confirm that knowledge deficits and comfort level gaps exist among IC staff. A nurse-led education intervention proves effective in increasing IC staff knowledge and comfort levels treating sickle cell pain in the IC setting. Implementing an education intervention to increase IC staff knowledge about SCD creates an opportunity to optimize IC staff competence and comfort in treating patients with SCD. This education is critical for compassionate care of this vulnerable population and transcending racial bias and disparities.