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Sickle cell acute painful episode overview

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These are the paths in the Sickle cell acute painful episode pathway:

Sickle cell acute painful episode HAI

About

What is covered

This pathway covers the management of an acute painful sickle cell episode in patients presenting to hospital until discharge.
Sickle cell disease is the name given to a group of lifelong inherited conditions of haemoglobin formation. Most people affected are of African or African-Caribbean origin, although the sickle gene is found in all ethnic groups.
Acute painful sickle cell episodes (also known as painful crises) are caused by blockage of the small blood vessels in people with sickle cell disease. These episodes are often unpredictable. Pain may vary in intensity, but can be excruciating. Repeated episodes may result in organ damage.
The management of acute painful sickle cell episodes is variable throughout the UK, and this is a frequent source of complaints from patients. Common problems include unacceptable delays in receiving analgesia, insufficient or excessive doses, inappropriate analgesia, and stigmatising the patient as drug seeking.
Areas covered in this pathway include the use of pharmacological and non-pharmacological interventions, identifying the signs and symptoms of acute complications, skills and settings for managing an acute painful episode, and the information and support needs of patients.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on:

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

9 April 2014 Minor maintenance update
2 January 2014 Minor maintenance updates.
22 February 2013 Minor maintenance updates.
17 July 2012 Minor maintenance updates.

Short Text

Sickle cell acute painful episode: management of an acute painful sickle cell episode in hospital

What is covered

This pathway covers the management of an acute painful sickle cell episode in patients presenting to hospital until discharge.
Sickle cell disease is the name given to a group of lifelong inherited conditions of haemoglobin formation. Most people affected are of African or African-Caribbean origin, although the sickle gene is found in all ethnic groups.
Acute painful sickle cell episodes (also known as painful crises) are caused by blockage of the small blood vessels in people with sickle cell disease. These episodes are often unpredictable. Pain may vary in intensity, but can be excruciating. Repeated episodes may result in organ damage.
The management of acute painful sickle cell episodes is variable throughout the UK, and this is a frequent source of complaints from patients. Common problems include unacceptable delays in receiving analgesia, insufficient or excessive doses, inappropriate analgesia, and stigmatising the patient as drug seeking.
Areas covered in this pathway include the use of pharmacological and non-pharmacological interventions, identifying the signs and symptoms of acute complications, skills and settings for managing an acute painful episode, and the information and support needs of patients.

Sources

The NICE guidance that was used to create the pathway.
Sickle cell acute painful episode. NICE clinical guideline 143 (2012)

Quality standards

Sickle cell acute painful episode

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statements

Timely assessment and analgesia

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

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. Contained within NICE clinical guideline 143 clinical audit tool, audit standards 2 and 3.
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. Contained within NICE clinical guideline 143 clinical audit tool, audit standard 1.

What the quality statement means for service providers, healthcare professionals and commissioners

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.

What the quality statement means for patients, service users and carers

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.

Source guidance

Definitions of terms used in this quality statement

Pain assessment
A pain assessment should assess the severity of pain using an age-appropriate pain scoring tool. [NICE clinical guideline 143, 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.
[NICE clinical guideline 143, 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 clinical guideline 143, 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.

Regular assessment of pain relief

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statement

People with an acute painful sickle cell episode have an assessment of pain relief every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours.

Rationale

Assessment of pain relief is important for determining the effectiveness of the analgesia given at the time of presentation. It is also important for ensuring that more painkillers are given when needed until the episode has ended or the patient is discharged. Using an age-appropriate pain scoring tool ensures consistency when assessing pain and helps healthcare professionals to ensure that pain relief is appropriate.

Quality measures

Structure
Evidence of local arrangements to ensure that people with an acute painful sickle cell episode have their pain relief reassessed every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours.
Data source: Local data collection.
Process
a) Proportion of people with an acute painful sickle cell episode who have their pain relief reassessed every 30 minutes after pain relief is started until satisfactory pain relief has been achieved.
Numerator – the number of people in the denominator who have their pain relief reassessed every 30 minutes after pain relief is started until satisfactory pain relief has been achieved.
Denominator – the number of people with an acute painful sickle cell episode.
Data source: Local data collection.
b) Proportion of people with an acute painful sickle cell episode who have achieved satisfactory pain relief who have their pain relief assessed at least every 4 hours until discharge or the end of the episode.
Numerator – the number of people in the denominator who have their pain relief assessed at least every 4 hours until discharge or the end of the episode.
Denominator – the number of people with an acute painful sickle cell episode who have achieved satisfactory pain relief.
Data source: Local data collection.
c) Proportion of people with an acute painful sickle cell episode who have their pain relief reassessed using an age-appropriate pain scoring tool.
Numerator – the number of people in the denominator who have their pain relief reassessed using an age-appropriate pain scoring tool.
Denominator – the number of people with an acute painful sickle cell episode.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that they have sufficient resources to reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours until discharge or the end of the episode.
Healthcare professionals ensure that they reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours until discharge or the end of the episode.
Commissioners ensure that they commission services that have sufficient resources to reassess pain relief in people with an acute painful sickle cell episode every 30 minutes until satisfactory pain relief has been achieved, and then at least every 4 hours until discharge or the end of the episode.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) have their pain relief checked every 30 minutes until they are comfortable and then at least every 4 hours until they leave hospital or their episode has ended.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendation 1.1.12.

Definitions of terms used in this quality statement

Assessment of pain relief
Assessment of pain relief should be done using an age-appropriate pain scoring tool and by asking questions such as:
  • How well did that last painkiller work?
  • Do you feel that you need more pain relief?
[NICE clinical guideline 143, recommendation 1.1.12]
Satisfactory pain relief
Satisfactory pain relief depends on the individual patient and is reached when the patient confirms that they are satisfied with their level of pain relief. [adapted from NICE clinical guideline 143]
Timing of assessments
Assessment of pain relief should be done every 30 minutes until satisfactory pain relief has been achieved and then at least every 4 hours when pain relief is satisfactory, until either discharge or the end of the acute painful sickle cell episode. [adapted from NICE clinical guideline 143]

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.

Strong opioids and monitoring

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statement

People with an acute painful sickle cell episode who are taking strong opioids are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours.

Rationale

Monitoring for adverse events in people with an acute painful sickle cell episode who are taking strong opioids is important to ensure patient safety. Monitoring is initially done hourly because the risk of adverse events is higher in the first 6 hours after first administration or a step up of pain relief.

Quality measures

Structure
Evidence of local arrangements to ensure that people with an acute painful sickle cell episode who are taking strong opioids have monitoring for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours.
Data source: Local data collection.
Process
a) Proportion of people with an acute painful sickle cell episode taking strong opioids who are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief.
Numerator – the number of people in the denominator who are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief.
Denominator – the number of people with an acute painful sickle cell episode taking strong opioids.
Data source: Local data collection.
b) Proportion of people with an acute painful sickle cell episode taking strong opioids who have had hourly monitoring for adverse events for the first 6 hours after first administration or step up of pain relief and who are then monitored for adverse events at least every 4 hours until discharge or the end of the episode.
Numerator – the number of people in the denominator who are monitored for adverse events at least every hour 4 hours until discharge or the end of the episode.
Denominator – the number of people with an acute painful sickle cell episode taking strong opioids who have had hourly monitoring for adverse events for 6 hours following first administration or step up of pain relief.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that they have sufficient resources for people with an acute painful sickle cell episode who are taking strong opioids to be monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.
Healthcare professionals ensure that people with an acute painful sickle cell episode who are taking strong opioids are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.
Commissioners ensure that they commission services that provide sufficient resources for people with an acute painful sickle cell episode who are taking strong opioids to be monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) who are taking strong painkillers (strong opioids) are checked for possible side effects every hour for the first 6 hours and then at least every 4 hours until they leave hospital or their episode has ended.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendation 1.1.16.

Definitions of terms used in this quality statement

Strong opioids
Strong opioids are drugs that have a similar action to morphine. They are mainly used for pain relief. Examples include morphine, diamorphine, fentanyl, oxycodone and buprenorphine. [Opioids in palliative care, NICE clinical guideline 140 – full guideline]
Monitoring for adverse events
Monitoring for adverse events is defined as a clinical assessment that includes a sedation score. [NICE clinical guideline 143, recommendation 1.1.16]
A clinical assessment should also assess:
  • blood pressure
  • oxygen saturation
  • pulse rate
  • respiratory rate
  • temperature.
Step up of pain relief
A step up of pain relief is either moving from a milder painkiller such as non-steroidal anti-inflammatory drugs/paracetamol to mild opioids and then to stronger opioids or an increase in dosage of analgesia. [Adapted from Analgesic Ladder, World Health Organization (1986) and expert opinion]
Timing of monitoring
Monitoring for adverse events should be done every hour for the first 6 hours and then at least every 4 hours, until either discharge or end of the acute painful sickle cell episode. Certain groups, for example, children and people on patient-controlled analgesia, may need to be monitored more frequently according to local protocols. [adapted from NICE clinical guideline 143 and expert opinion]

Acute complications

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statement

People with an acute painful sickle cell episode are assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

Rationale

Acute chest syndrome is a major cause of morbidity and mortality in people with sickle cell disease. It can progress rapidly and is not always recognised as a possible complication. Monitoring by clinical assessment, acting on any changes and assessing for acute chest syndrome may lead to this complication being identified and treatment started earlier.

Quality measures

Structure
a) Evidence of local arrangements to ensure that healthcare professionals caring for people with an acute painful sickle cell episode are aware of acute chest syndrome as a potential complication.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people with an acute painful sickle cell episode are assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.
Data source: Local data collection.
Process
Proportion of people with an acute painful sickle cell episode with 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia who are assessed for acute chest syndrome.
Numerator – the number of people in the denominator who are assessed for acute chest syndrome.
Denominator – the number of people with an acute painful sickle cell episode who have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that healthcare professionals caring for people with an acute painful sickle cell episode are aware of acute chest syndrome as a potential complication and that people with an acute painful sickle cell episode need to be assessed for acute chest syndrome if they have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.
Healthcare professionals ensure that they are aware of acute chest syndrome as a potential complication of an acute painful sickle cell episode and assess for acute chest syndrome if people have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.
Commissioners ensure that they commission services that have staff trained to recognise acute chest syndrome as a potential complication of acute painful sickle cell episode and to assess for acute chest syndrome if people with an acute painful sickle cell episode have 1 or more of the following: abnormal respiratory signs or symptoms, chest pain, fever, or signs and symptoms of hypoxia.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) who have any breathing problems, chest pain or fever are assessed for a serious lung condition called acute chest syndrome.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendation 1.1.19.

Definitions of terms used in this quality statement

Signs and symptoms of hypoxia
  • Oxygen saturation of 95% or below, or
  • An escalating oxygen requirement to maintain oxygen saturations of 95% or above.
[NICE clinical guideline 143, recommendation 1.1.19]

Protocols and specialist support

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statement

Healthcare professionals who care for people with an acute painful sickle cell episode have access to locally agreed protocols on treatment and management and specialist support from designated centres.

Rationale

The distribution of sickle cell disease varies throughout England; two-thirds of people with sickle cell disease live in London, and most others live in the other big cities. Therefore the demand for treatment and management of acute painful sickle cell episode differs across the country. To ensure high-quality care for all people with an acute painful sickle cell episode, healthcare professionals need to be able to access locally agreed protocols that set out treatment and management. They also need to know how to access specialist support from designated centres when needed.

Quality measures

Structure
a) Evidence of local arrangements to ensure that locally agreed protocols on how to treat and manage acute painful sickle cell episodes are available and reviewed regularly.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that all healthcare professionals who care for people with an acute painful sickle cell episode have access to specialist support from designated centres.
Data source: Local data collection.
Outcome
a) Staff awareness of how to access locally agreed protocols for treatment and management of acute painful sickle cell episodes.
Data source: Local data collection.
b) Staff awareness of how to access specialist support from their designated specialist centre.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that locally agreed protocols for treating and managing acute painful sickle cell episodes are available and regularly reviewed, and that healthcare professionals who care for people with an acute painful sickle cell episode are aware of and have access to these protocols. Service providers ensure that healthcare professionals know how to access specialist support for sickle cell care from designated centres.
Healthcare professionals who care for people with an acute painful sickle cell episode ensure that they have access to locally agreed protocols on treatment and management and know how to access specialist support for sickle cell care from designated centres.
Commissioners ensure that they commission services for people with an acute painful sickle cell episode, which have access to locally agreed protocols for treatment and management. Commissioners should engage with local and specialist services to designate centres that can offer specialist support, and should ensure that the specialist centres have the resources to do this.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) are cared for by healthcare professionals who can follow locally agreed procedures for managing the condition and can get support from specialist centres if needed.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendations 1.1.1 and 1.1.25.

Discharge information

These quality statements are taken from the sickle cell acute painful episode quality standard. The quality standard defines clinical best practice for sickle cell acute painful episode and should be read in full.

Quality statement

People with an acute painful sickle cell episode are given information before discharge on how to continue to manage their current episode.

Rationale

People with an acute painful sickle cell episode who are discharged from hospital need written information on accessing specialist advice, managing side effects of treatment and obtaining additional medication. This applies to everyone whether they are still taking strong opioids at the time of discharge or whether the episode ended while they were in hospital. Because sickle cell disease is a rare condition everyone should have this information so that they can discuss their needs with other healthcare professionals who are involved in continuing care.

Quality measures

Structure

Evidence of local arrangements to ensure that people with an acute painful sickle cell episode are given information before discharge on how to continue to manage their current episode.
Data source: Local data collection.

Process

Proportion of people with an acute painful sickle cell episode (or their parents or carers if appropriate) who are given information before discharge on how to continue to manage their current episode.
Numerator – the number of people in the denominator (or parents or carers if appropriate) who are given information on how to continue to manage their current episode.
Denominator – the number of people with an acute painful sickle cell episode who are discharged from hospital.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers ensure the availability of information on how to continue to manage acute painful sickle cell episodes. They should also ensure protocols are in place for people to be provided with this information before discharge.
Healthcare professionals give people with an acute painful sickle cell episode, information before discharge on how to continue to manage their current episode.
Commissioners ensure that they commission services in which people with an acute painful sickle cell episode are given information before discharge on how to continue to manage their current episode.

What the quality statement means for patients, service users and carers

People with a painful attack of sickle cell disease (acute painful sickle cell episode) are given information before they leave hospital on how to get specialist support, how to get extra medication and how to manage any side effects of the treatment.

Source guidance

  • Sickle cell acute painful episode (NICE clinical guideline 143), recommendation 1.1.28.

Definitions of terms used in this quality statement

Discharge information

Written information on:
  • how to obtain specialist support
  • how to obtain additional medicines
  • how to manage any side effects of the treatment they have received in hospital
[NICE clinical guideline 143, recommendation 1.1.28]

Equality and diversity considerations

All discharge information given to people with an acute painful sickle cell episode should be culturally appropriate and accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English. People with an acute painful sickle cell episode should have access to an interpreter or advocate if needed.
It may be appropriate in some cases, particularly with children and young people or those with learning disabilities, to provide information to parents and carers as well as the person with the acute painful sickle cell episode.

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Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on:

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

9 April 2014 Minor maintenance update
2 January 2014 Minor maintenance updates.
22 February 2013 Minor maintenance updates.
17 July 2012 Minor maintenance updates.

Supporting information

Glossary

The administration of a medication, drug or other compound that is given to raise its concentration to an effective level. Administration can be intravenous, intramuscular, intrathecal or subcutaneous.
A pathological condition in which a part of or the whole body is deprived of adequate oxygen supply.
Pain with a visual analogue scale (VAS) (or equivalent) score typically within the range of 4 to 7 (this description should not be interpreted as a strict definition and will not apply to all patients, as pain is subjective). [The VAS is a pain scoring tool measured on a linear scale from 0 to 10, with 0 indicating no pain.]
Patient-controlled analgesia (PCA) is a method of safely administering strong opioids which is controlled by the patient (or a nurse for nurse-controlled analgesia).
Pain with a visual analogue scale (VAS) (or equivalent) score typically above 7 (this description should not be interpreted as a strict definition and will not apply to all patients, as pain is subjective). [The VAS is a pain scoring tool measured on a linear scale from 0 to 10, with 0 indicating no pain.]

Paths in this pathway

Pathway created: June 2012 Last updated: April 2014

© NICE 2014

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