advanced practice nurses, emergency department, evidence-based care, Levine's theory, quality improvement, sickle cell pain



  1. Odesina, Victoria DNP, APRN, PHCNS-BC, CCRP, APNG
  2. Bellini, Sandra DNP
  3. Leger, Robin PhD, RN
  4. Bona, Robert MD
  5. Delaney, Colleen PhD, RN, AHN-BC
  6. Andemariam, Biree MD
  7. Bacarro, Nancy APRN, AOCN, ANP, PCM-BC, MS
  8. Lundquist, Kathleen MSN
  9. Donahoe, Sandra P. BSIE, MBA, CPHQ
  10. D'Angelo, Susan RN
  11. Gorenbeyn, Aleksandr MD
  12. Goodrich, SueEllen MSN
  13. Tafas, Cheryl D. RN, MS


This quality improvement project addressed the gaps in sickle cell pain management at a suburban teaching hospital emergency department. The aims were to (1) measure baseline pain management practices for patients with sickle cell disease in the ED and (2) implement an adapted emergency department sickle cell pain management clinical pathway. A retrospective chart review was conducted for data abstraction on pain management practices. Medical record review from 44 patient visits showed a high use of monotherapy, delay in time to medical evaluation, medication order, and time to first and subsequent analgesic administration and pain reassessments. Results were used by a multidisciplinary team to develop and implement an evidence-based clinical pathway to improve sickle cell disease pain management. The clinical pathway development was guided by both the advancing research through close collaboration model (ARCC) and Levine's principles of conservation to provide holistic care while preserving vital organs.