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Exploring Emergency Department Provider Experiences With and Perceptions of Weight-Based Versus Individualized Vaso-Occlusive Treatment Protocols in Sickle Cell Disease

Knight, La'Kita M. J., MSN, FNP-C, BSN, BS, RN; Onsomu, Elijah O., PhD, MPH, MS, MCHES; Bosworth, Hayden B., PhD; Crawford, Regina D., MD; DeMartino, Theresa, BS; Glassberg, Jeffrey, MD; Paice, Judith A., PhD, RN; Miller, Christopher N., MD, MS; Richardson, Lynne, MD; Tanabe, Paula, PhD, RN, FAEN, FAAN

Advanced Emergency Nursing Journal: January/March 2019 - Volume 41 - Issue 1 - p 86–97
doi: 10.1097/TME.0000000000000232
PROCEDURAL COLUMN
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Treatment of vaso-occlusive episodes (VOEs) is the most common reason for emergency department (ED) treatment of sickle cell disease (SCD). We (1) compared perceptions of the usability and ability to manage VOE pain between ED nurses and other ED provider types, ED sites, and VOE protocols (individualized vs. weight-based), and (2) identified ED nurse and other provider protocol suggestions. A secondary analysis of provider survey data collected immediately after caring for a patient enrolled in a randomized controlled trial comparing weight-based versus individualized opioid dosing for VOE. Research staff asked the ED nurses and other ED providers (nurse practitioners [NPs], physician assistants [PAs], residents, and attending physicians) 5 questions related to the protocol's ease of use and ability to manage pain. There were 236 surveys completed. Attending physicians (n = 15), residents (n = 88), PAs (n = 21), and NPs (n = l) were more satisfied than nurses (n = 111) with the clarity of the analgesic ordering (97.6% vs. 0%, p = 0.0001) and ability to manage the patient's VOE pain (91% vs. 0%, p = 0.0001). When comparing both protocols with the usual ED strategy in their ED to manage VOE, more nurses than other ED providers perceived the study patients' pain management protocol as better (100% vs. 35.2%, p = 0.0001). Other ED providers perceived the individualized versus weight-based protocol as better at managing pain than their usual ED strategy (70.3% vs. 59.5%, p = 0.04). The individualized protocol was perceived as better in managing VOE than the weight-based ED strategy. While physicians were satisfied with the clarity of the protocols, nurses were not. Improved protocol usability is required for widespread ED implementation.

School of Nursing, Winston–Salem State University, Winston–Salem, North Carolina (Ms Knight and Dr Onsomu); Department of Population Health Sciences (Dr Bosworth), Department of Medicine, Psychiatry & Behavioral Sciences (Dr Bosworth), Division of Hematology (Dr Crawford), Department of Medicine (Drs Crawford and Tanabe), and School of Nursing (Mss Knight and DeMartino and Drs Bosworth and Tanabe), Duke University, Durham, North Carolina; Icahn School of Medicine at Mount Sinai (Drs Glassberg and Richardson); Division of Hematology-Oncology (Dr Paice) and Feinberg School of Medicine (Dr Paice), Northwestern University, Chicago, Illinois; and Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine (Dr Miller).

Corresponding Author: La'Kita Knight, MSN, FNP-C, BSN, BS, RN, Duke University, DUMC 3322, 307 Trent Dr, Durham, NC 27710 (lakita.knight@duke.edu).

This project was funded by the National Heart, Lung and Blood Institute (R34 RHL121224A, Paula Tanabe, PhD, RN, FAEN, FAAN, principal investigator. Drs. Glassberg, Richardson, and Miller were coinvestigators and with Ms Martino all received salary support. Dr. Tanabe also has funding from the Agency for Healthcare Research and Quality, R18 RHS024501A, and the NIH, U01HL133964).

Disclosure: The authors report no conflicts of interest.

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