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Care of Sickle Cell Disease Patients: Process Improvement & Change with Nurses

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Populations with SCD are at risk for disparities primarily because of the lack of knowledge on the part of the healthcare providers regarding the disease; inadequate pain management and prejudice among the staff (Tanabe & Myers, 2007).

On interviewing several nurses in the hospital, many acknowledge that they have never taken care of a patient with SCD and do not know what to assess for. The only nurse with experience of taking care of a SCD patient did not know the complications of the disease and wondered why sickle cell patients “always request pain medication when it’s obvious they are not in pain.”

This presentation is a guide providing essential information to medical professionals on dealing with patients that have sickle cell anemia. In addition, the SCD questionnaire is designed to enhance the assessment of SCD patients by medical professionals in the emergency room and serve as a platform for understanding their vulnerabilities during assessment.

Emphasis of this questionnaire is placed on identifying risk factors for depression, the patient’s socio-economic barriers, lifestyle habits, transportation issues, safe home environment, effective pain management and avenues for possible genetic counseling all of which sickle cell patients have shown vulnerability to (Dorsey & Murdaugh, 2003).

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Care of Sickle Cell Disease Patients: Process Improvement & Change with Nurses

  1. 1. Process Improvement and Change Presentation By: Tosin Ola, RN, BSN
  2. 2. Introduction Sickle cell disease affects 12, 000 people in the western United States SCD affects those of African, Hispanic, and Caribbean ancestry but the trait is found in almost all other races. Nurses expressed concerns related to assessment, care and treatment of SCD patients due to lack of knowledge and practice
  3. 3. Need for Enhancement SCD patients are a vulnerable population at risk for disparities Questionnaire will be used in the emergency room and medical units during assessment and will help craft the nursing care plan
  4. 4. Regulatory Forces Healthy People 2020  Joint Commission objectives 2009 National Patient  Eliminate health Safety Goals disparities  Patient involvement in  Reduce SCD care hospitalizations  Early assessment of  Blood disorders and complications blood safety  Identify at-risk patients World Health  Prevent infection Organization  Infection prevention
  5. 5. Benchmarking Mortality Cost of SCD hospitalizations is $1.1 billion annually Re-hospitalizations are usually within 30 days
  6. 6. Patient Satisfaction Patient dissatisfaction is related to inadequate pain relief and miscommunication Inadequate pain management leads to provider mistrust, passivity and aggressiveness
  7. 7. Improved Efficiency Sickle Cell Vulnerability Assessment will improve efficiency with:  Nurses/doctors in assessment  Development of care plan  Pain management  Patient advocacy  Management of vulnerabilities  Self care management
  8. 8. Methodology Demographics Medical history Blood transfusions Pain assessment SC Vulnerabilities  Financial  Insurance  Job  Transportation  Triggers of crises
  9. 9. SCD Vulnerabilities cont. Lifestyle  Mental health  Exercise  Depression  Alcohol/Tobacco use  Suicidal ideations  Illicit drugs  Herbal remedies  Stress Sexual activity  Contraception  Pregnancy  Genetic counseling Personal safety  Living arrangements  Abuse
  10. 10. Change Theory and Leadership Style Lewin’s 3-Step Change Model  Unfreezing  Moving, transition  Refreezing Leadership style  Achievement-oriented leadership style
  11. 11. PDCA Cycle Plan Do Act Check/Correct
  12. 12. Timeline • Review SCVA with key stakeholdersWeek OneWeek Two • Test implementation in ER pod A and CCU • Reassessment and evaluation of outcomesWeek Four • Modify SCVA according to pinpointed needs • Roll out SCVA on all medical units and EDWeek Five • Instructional sessions by key stakeholders to the whole hospital • Full implementation of SCVA hospital wideWeek Six
  13. 13. Implementation Strategies 1 hour seminar to key  Patient satisfaction monitors surveys Education during unit  Weekly audits meeting  People Pulse Key Monitors available  Press Ganey for questions
  14. 14. Research Literature Proper assessment Pain management Self management Assessment of vulnerabilities
  15. 15. Summary Proper assessment Sickle cell vulnerability assessment Improved patient health and satisfaction scores
  16. 16. ReferencesAmerican Academy of Pediatrics (2002, May 1). Health supervision for children with sickle cell disease (Hematology/Oncology Committee on Genetics). Elk Grove, IL: Author.American Society of Hematology (2009, December 5). Outpatient Follow-up and Re-hospitalization for Sickle Cell Disease in Wisconsin Medicaid (Health Outcomes Research). New Orleans, LA: American Society of Hematology.American Society of Hematology (2008). SCD hospital volume linked to mortality. Hem/Onc Today, p. 25. Retrieved December 13, 2009 from Academic Search Complete database.Dorsey, C. J., & Murdaugh, C. L. (2003). The theory of self care management for vulnerable populations. The Journal of Theory Construction and Testing, 7(2), 43-49. Retrieved December 15, 2009 from Academic OneFile.Fiaskerud, J. H., Kim, S., Strehlow, A., Tullman, D., Verzemniek, I., & Koniah-Criffin, D. et al. (2002). Health disparities among vulnerable populations: Evolution of knowledge over five decades in Nursing Research publications. Nursing Research, 5(2), 74-85. Retrieved December 17, 2009 from ProQuest.Getty Images (2009). Keyword, “Healthcare images”. Retrieved December 18, 2009, from http://gettyimages.com
  17. 17. References continuedGoldberg, J., Hayes, W., & Huntley, J. (2004, November). Understanding Health Disparities. Retrieved December 16, 2009 from Health Policy Institute of Ohio: http://healthpolicyohio.org/pdf/healthdisparities.pdfHealthy People 2020 (2009). Proposed Healthy People 2020 Objectives. Retrieved December 17, 2009, from http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspxJoint Commission (2009). National Patient Safety Goals. Retrieved December 16, 2009, from http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/Kauf, T. L., Coates, T. D., Huazhi, L., Mody-Patel, N., & Hartzema, A. G. (2009). The cost of health care for children and adults with sickle cell disease. Journal of Hematology, 84(6), 323-327.National Heart, Lung and Blood Institute (2007). Sickle Cell Anemia. Retrieved December 18, 2009, from http://www.nhlbi.nih.gov/health/dci/index.htmlPrabhakar, H. (2009). Developing an Expert Patient Program for Sickle Cell Disease in the United States. Retrieved December 15, 2009, from www.scinfo.org/scdeppv1.pdfSpector, B. (2010). Implementing organizational change: theory into practice (2nd ed.). New York: Prentice Hall.
  18. 18. References continuedSchien, E. H. (2002). Models and tools for stability and change in human systems. Reflections, 4(2), 34-46.Steiner, C., & Miller, J. (2006, December). Sickle cell disease patients in U.S. hospitals, 2004 (Agency for Healthcare Research and Quality). Rockville, MD: HCUP.Strickland, O. I., Jackson, G., Jilead, M., Mcguire, D. B., Quarles, S., & Douglas, P. et al. (2001). Use of focus groups for pain and quality of life assessment in adults with sickle cell disease. Journal of the National Black Nurses Association, 12(2), 36- 43.Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing (7th ed.). Upper Saddle River, NJ: Prentice Hall.Sutton, D. (2008). Eliminating Health Disparities: Case Study of a Sickle Cell Clinic. Retrieved December 16, 2009, from http://www.aha.org/aha/content/2008/pdf/08dispcase-sicklecellclinic.pdfTanabe, P., & Myers, R. (2007). Emergency department management of acute pain episodes in sickle cell disease. Emergency Medicine, 14(2), 419-425. Retrieved December 14, 2009 from Academic OneFile.World Health Organization. (2009). WHO objectives for 2010. Retrieved December 18, 2009 from http://who.org

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