P1504: AN AUDIT OF PAIN EDUCATION IN PATIENTS WITH SICKLE CELL DISEASE

Abstract

Background: Pain crises represent the primary reason for hospital care-seeking in individuals with sickle cell disease (SCD). The NICE guideline CG143 emphasises that patient should be treated as experts in the pain management of their sickle cell disease. Aims: To assess the performance of acute sickle cell pain crisis management at Cambridge University Hospital (CUH) and assess methods of secondary prevention of admission for pain crisis through patient pain education. Methods: Patient admission records during the year of 2021 were reviewed for a population of 85 SCD patients registered at Cambridge University Hospital (CUH). For these encounters, patient assessment at presentation, primary analgesia and ongoing management were audited against CG143 standards. All SCD patients registered with CUH were contacted for a telephone interview to discuss home pain management. Results: In a population of 85 patients living with SCD, there were 22 admissions in 17 patients during 2021, of which 5 patients had multiple admissions. Auditing CUH performance against the NICE CG143 guidelines, it was found that initial pain relief was provided within 30 minutes of presentation in 15 out of the 21 relevant admissions (71%). However, none of the patients had documented discussion of pain control education, any psychological support they may need nor were encouraged to use their own coping mechanisms for dealing with acute pain in their hospital notes. Following on from this, we conducted telephone interviews and received a total of 51 responses of which 13 patients were admitted to hospital with sickle cell pain in 2021. In the 46 patients who experience sickle cell pain crises, 20 had strong opiates, 27 had weak opiates, and all 46 had a supply of paracetamol/non-steroidal anti-inflammatory drugs (NSAIDs). 8/20 (40%) patients with a home supply of strong opiates were admitted to CUH with an acute sickle cell pain crisis in 2021 compared to 5/26(19.2%) in those who did not have strong opiates at home. Notably, only 6/46 patients were familiar with the World Health Organisation pain ladder. 2 of 6 patients who were aware of the WHO pain ladder had an admission to CUH in 2021, while 11 of 40 patients who were not aware had an admission to CUH in 2021. The findings are summarised in Table 1. Image:Summary/Conclusion: Our audit has demonstrated a significant gap in the management of acute sickle cell pain crises at CUH with the absence of patient pain education. This may have contributed to the number of admissions of SCD patients to CUH. The limited patient knowledge of optimal use of pain control in line with WHO pain ladder is significant, given that most episodes are managed at home. Frequent painful crises are associated with psychological issues and poor engagement in normal daily activities. Better home pain control should be a future priority for our service.