Empowering Home Pain Management in Sickle Cell Disease: Standardizing EMR-Based Outpatient Action Plans

Sickle cell disease (SCD) causes unpredictable vaso-occlusive pain episodes, requiring effective outpatient pain management. Historically, outpatient pain plans were primarily paper-based and rarely documented in the electronic medical record (EMR), limiting provider access and confirmation that a plan existed. This quality improvement (QI) initiative aimed to increase the distribution and documentation of outpatient pain action plans (OPAPs) from 0% to 75% in six months and maintain it for one year. Secondary aims included improving home pain management satisfaction and reducing emergency department (ED) visits.

Using QI methodology, a multidisciplinary team identified barriers, including EMR limitations, clinic workflow, printer availability, and language accessibility. Previously, no documented pain plans were found on chart review. A key driver diagram guided multiple Plan-Do-Study-Act (PDSA) cycles to develop an EMR-integrated OPAP and a standardized workflow for creation, updating, and distribution. Eligible patients included English-speaking individuals with SCD older than 6 months, who were not followed by the chronic pain clinic. An up-to-date OPAP was defined as those completed within the past 12 months. QI Macros and statistical process control charts were used for analysis.

Between September 16, 2021, and July 6, 2023, up-to-date OPAP documentation increased from 0% to 59%. Audited sustainability data demonstrated continued improvement, reaching 84% in 2024. Admissions through the ED or infusion room remained unchanged. Of surveyed families, 85% (22/26) rated the pain plan 5/5 stars, highlighting its value in guiding medication scheduling and alternative pain relief interventions.

Standardizing EMR-based OPAPs improved documentation and accessibility for providers. Family satisfaction with home pain management during the post-intervention periods was high. Future efforts include refining templates, expanding language accessibility, and strengthening transitions between inpatient and outpatient pain plans.