A Clinical Decision Tool for Sickle Cell Disease

Leigh Ann Wilson is a licensed clinical social worker and Collin Montgomery is the program coordinator for the Adult Sickle Cell Program, both at the University of Arkansas for Medical Sciences in Little Rock. Why and how did they develop a clinical decision tool to standardize opioid prescribing for patients with sickle cell disease? Their #1 suggestion on How-to: Put on paper what is done in clinical practice. Their #1 reason: It keeps everyone on the same page with every single patient and helps manage the pain in adult sickle cell disease.

The algorithm addresses

• Mental health in the sickle cell patient
• If they have any disease-related complications, including those that can be corrected with surgery
• Nonpharmacologic, nonopioid management
• How to improve patient quality of life
• If this patient actually just has chronic pain that needs to be managed
• If their opioids need to be increased or decreased

What problems were encountered?

• Limited research in the adult sickle cell population, especially as it pertains to chronic pain
• An inherited significant number of patients from a community provider
• No dedicated physician; we have rotating hematologists

Overall positives seen:

• 50% to 75% reductions in MMEs per day
• Fewer opioids due to adjuvant therapies
• Fewer opioids due to surgery for repairs or to fix complications
• Improved mental health due to less resistance to counseling