Assessing adherence of opioid use to established guidelines for pain management in sickle cell disease at sickle cell ward, Mulago Hospital

Abstract

Sickle cell disease is a hereditary condition resulting from a mutation in the beta globin chain of hemoglobin where valine is substituted for glutamic acid at position 6. Cardinal features of SCD are hemolytic anemia and vaso-occlusion characterized by severe pain with the vaso-occlusive events being the most common cause of hospital admissions, missed school days and morbidity in patients with SCD. Pain management in SCD involves use of opioids among other pharmacological classes of analgesics. Due to potential for abuse, opioid-induced hyperalgesia and development of tolerance, standardized protocols need to be put in place and adhered to in acute care settings to ensure safe and effective use while optimizing patient outcomes. The major objective of this study was to assess adherence of opioid use to established guidelines for management of pain associated with sickle cell disease. A descriptive cross sectional study design was used to extract medical information from 268 patient books sampled consecutively. A checklist questionnaire was used to extract the data which was then filled into Microsoft Excel, analyzed using Jamovi version 2.3.28.0., and presented in tables, figures and graphs. Of the 268 subjects whose information was reviewed, 140(52.2%) were male. Most of the study subjects that presented with acute pain crises 87(32.2%) were in the age range of 0 to 5 years. Adherence of the opioid prescriptions to the Uganda Clinical Guidelines for management of pain in SCD was observed in only 120(44.8%) subjects. The study showed that there was low adherence of opioid use to established guidelines for pain management in SCD patients at the sickle cell ward, Mulago Hospital owing to a number of reasons.