Background: A vaso-occlusive episode (VOE) is a common complication of sickle cell disease (SCD). The most common presentation of VOE is pain that, if undertreated, can lead to life-threatening complications. Nearly all persons with SCD will have a VOE, however, data show that patients frequently receive inadequate analgesia when being treated for acute pain related to VOEs. The recent opioid climate has potentially worsened this problem by restricting opiate use in some cases. Oregon Health & Science University (OHSU) created a guideline-development process to adapt external guidelines to local needs, integrating evidence-based practice methodology with clinical expertise and patients’ values and preferences.
Purpose: The primary goal of this project is to develop and implement a guideline for treating VOE in people living with SCD.
Description: The guideline development process begins with forming a content expert team consisting of clinicians from various departments, hospital leadership, methodology experts, and patient representatives. The content expert team defines the clinical needs the guideline will address. The methodology team then searches international, national, state, and institutional guidelines addressing these needs, and then appraises them using the Trustworthy Guideline rating scale. External guideline recommendations are synthesized and adapted into practice recommendations and consensus statements for local clinical and patient needs and then shepherded through an institutional approval process. Accompanying clinical decision support tools, such as order sets, and quality metrics are then developed to support implementation of best practice.
Twenty content experts from multiple disciplines and departments, as well as one patient with SCD helped develop this guideline on acute pain management for patients with SCD presenting with VOE. The guideline will be approved by the institutional Professional Board, and implementation will involve developing decision-support tools and order sets, as well as updating institutional policies regarding use of patient-controlled analgesia devices (PCAs) to reflect current recommendations. The interdisciplinary team will also develop metrics to track clinical outcomes upon implementation.
Conclusions: OHSU’s evidence-based practice process demonstrates how a multidisciplinary team can develop and implement guidelines using existing peer-reviewed guidelines, local clinical expertise, and patient values and preferences to improve coordinated and consistent delivery of care. We anticipate this guideline will improve outcomes for patients with SCD presenting with acute pain from VOE.