Sickle cell program prevents ED visits, admits
Sickle cell program prevents ED visits, admits
Education, access to specialists are keys to success
In the first four months, Horizon/Mercy’s sickle cell disease management had identified 111 members with sickle cell and started an education program to help them avoid a painful crisis and hospital admissions.
"Sickle cell is a high-cost disease with a lot of inpatient admissions. We think that by educating our members and linking them to hematologists, we can prevent unnecessary admissions," says Giavanna Ernandes, RN, MSN, APNC, team leader for disease management, including the sickle cell program.
Members are identified when they are hospitalized, visit the emergency room, or see a physician for the disease.
Ernandes expects that the winter months will result in identification of far more members because sickle cell disease is exacerbated by cold weather.
When a member with sickle cell disease is identified, the nurse case manager calls him or her, or the parents if the member is a child.
The case managers follow up regularly with the sickle cell patients, depending on the level
of severity.
They ask about how the disease affects the members, hospital admissions, episodes of severe pain, and what kind of medical care the member has been receiving.
They provide educational materials, follow up with the primary care physician or specialists, and contact the pharmacist to look at utilization of medication.
"We go over cases to make sure they are being managed appropriately and, if not, we try to find a better avenue for them," Ernandes says.
Recognizing triggers
The case managers arrange for the member to see a physician or nurse practitioner, and in some cases a hematologist or a pain control specialist if that is what he or she needs.
"It all goes back to the crux of our mission and vision. Before we started this program, those people had no idea they could go to a center of excellence for care. We provide transportation to get them there and hook them up to a physician
who is a champion of their cause," says Pamela Persichilli, RNC, director of clinical operations for Horizon/Mercy.
People with sickle cell disease have misshapen red blood cells that make it difficult for enough oxygen to get to their tissues. When they are injured, sick, or exposed to cold, their bodies are under more stress and need more oxygen, but their tissues can’t get it because of the misshapen red blood cells.
The case managers work with the sickle cell patients to recognize the things that trigger a crisis, such as being cold, patient falls, or certain illnesses. They see that they are immunized for flu and pneumonia because illness also can prompt a crisis.
They teach them to take pain medication at the beginning of an episode and to put ice packs on their joints rather than waiting for the pain to become so severe that they go to the emergency room or have to be admitted to the hospital.
"We also teach them to recognize the times when they definitely should call their primary care physician or go to the emergency room," Ernandes adds.
In the first four months, Horizon/Mercys sickle cell disease management had identified 111 members with sickle cell and started an education program to help them avoid a painful crisis and hospital admissions.Subscribe Now for Access
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