Registed Nurses' Association of Ontario

Developing Clinical Skills Necessary to Support Complex Therapeutic Care in a Day Hospital Setting For Patients with Sickle Cell Anemia

Cheryl-Anne Bondy
The Ottawa Hospital

Over the last 12 weeks I have increased my knowledge of sickle cell disease, specifically in the area of pain and the management of pain. It is a complex issue that requires a multifaceted health care approach.

The pain that these patients endure is equivalent to that of passing a kidney stone, but unfortunately it is not recognized as such. I have taken the opportunity to pass along my knowledge of this pain to several nursing units that have contact with these patients. A plan is in place with unit educators for future presentations, specifically focusing on pain assessment and pain management.

I have done a lot of one on one teaching in a variety of settings, specifically our emergency department, with RN’s and some physicians taking care of sickle cell patients during a pain crisis.

My experience at the Pain Clinic at the Ottawa Hospital was amazing. The progress in the variety of pain medications and their delivery gives hope to those who suffer with pain. Consulting the Pain Clinic is a new chapter for sickle cell patients specifically in the area of chronic pain. As well, a new relationship has developed with the Pain Clinic and an addiction specialist from the Ottawa area. The few sickle cell patients that do have addiction issues now have access to this specialist through the Pain Clinic. My exposure to addictions, misuse and abuse of medications has given me the knowledge to assess and create tools to utilize in our weekly sickle cell clinics.

We are in the process of improving transitional care of sickle cell patients from pediatrics to our adult facility. Literature dictates that transitional care is essential to the future health of the sickle cell patient. I feel better equipped to create a smoother transition for these patients and have instilled a ‘Transition Protocol’ as part of our care of new transfers.

These patients have a variety of treatments/interventions that require intravenous therapy. Ultrasound guided IV insertion is another avenue to access the sickle cell patients with difficult veins. I’ve had to opportunity to be trained in this skill and have created a policy and procedure for the Ottawa Hospital. The next in line will be the Apheresis team that perform red cell exchanges on these patients.

The idea of a Day Hospital for the outpatient care of sickle cell patients is a future hope of the Ottawa Hospital. There are many diseases that are well cared for in an outpatient setting i.e. cancer, MS etc. Sickle cell anemia patients’ would benefit a great deal, specifically in the area of pain management in an outpatient setting. Our population of these patients is increasing and only when the cost of bed admissions exceeds the cost of an outpatient bed will a change take place of bed allocations. Until then we will keep tracking these numbers.

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