Quality standard

Quality statement 1: Timely assessment and analgesia

Quality statement 1: Timely assessment and analgesia

Quality statement

People who present at hospital with an acute painful sickle cell episode have a pain assessment, a clinical assessment and appropriate analgesia within 30 minutes of presentation.

Rationale

A thorough and rapid assessment at presentation is needed to ensure that people with an acute painful sickle cell episode have an accurate diagnosis. Pain assessment should be performed using an age-appropriate pain scoring tool. This ensures that adequate analgesia is given and will inform future management. If acute pain is not recognised and adequate analgesia is not given promptly, the pain may escalate, causing unnecessary distress and deterioration in the person's condition.

Quality measures

Structure

Evidence of local arrangements to ensure that people who present at hospital with an acute painful sickle cell episode have a pain assessment, a clinical assessment and appropriate analgesia within 30 minutes of presentation.

Data source: Local data collection.

Process

a) Proportion of people who present at hospital with an acute painful sickle cell episode and have a pain assessment, a clinical assessment and appropriate analgesia within 30 minutes of presentation.

Numerator – the number of people in the denominator who have a pain assessment, a clinical assessment and appropriate analgesia within 30 minutes of presentation.

Denominator – the number of people who present at hospital with an acute painful sickle cell episode.

Data source: Local data collection.

b) Proportion of people who present at hospital with an acute painful sickle cell episode who have their pain assessed using an age-appropriate pain scoring tool.

Numerator – the number of people in the denominator who have their pain assessed using an age-appropriate pain scoring tool.

Denominator – the number of people who present at hospital with an acute painful sickle cell episode.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that they have sufficient resources to assess both pain and clinical signs in people who present at hospital with an acute painful sickle cell episode and to give appropriate analgesia within 30 minutes of presentation.

Healthcare professionals ensure that they assess both pain and clinical signs in people who present at hospital with an acute painful sickle cell episode and give appropriate analgesia within 30 minutes of presentation.

Commissioners ensure that they commission services that have sufficient resources to assess both pain and clinical signs in people who present at hospital with an acute painful sickle cell episode and give them appropriate analgesia within 30 minutes of presentation.

People who go to hospital with a painful attack of sickle cell disease (acute painful sickle cell episode) have their pain, blood pressure, blood oxygen levels, heart rate, breathing rate and temperature checked, and are given the right amount of pain relief within 30 minutes of arriving.

Definitions of terms used in this quality statement

Presentation

The arrival time in the emergency department.

Pain assessment

A pain assessment should assess the severity of pain using an age-appropriate pain scoring tool. [NICE's guideline on sickle cell disease, recommendation 1.1.3]

Clinical assessment

A clinical assessment should check whether the pain is due to an acute painful sickle cell episode or another cause, and should include assessment of the following clinical signs:

  • blood pressure

  • oxygen saturation

  • pulse rate

  • respiratory rate

  • temperature.

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes. [NICE's guideline on sickle cell disease, recommendations 1.1.5 and 1.1.6]

Appropriate analgesia

Appropriate analgesia must take into account any pain relief taken by the patient for the current episode before presenting at hospital, and ensure that the drug, dose and administration route are suitable for the severity of the pain and the age of the patient. [NICE's guideline on sickle cell disease, recommendation 1.1.7]

Equality and diversity considerations

Most people with sickle cell disease are of African or African-Caribbean origin. This may mean that language needs to be taken into account when deciding on the type of pain scoring tool to be used. Age, especially if the person is a young child, and any physical, sensory or learning disabilities also need to be taken into account.

In young children, people with learning disabilities and people in great pain, it may not be possible to determine the cause of the pain initially without a fuller examination.