Asia Pac Allergy.  2016 Jan;6(1):29-34. 10.5415/apallergy.2016.6.1.29.

Anaphylaxis audit in a busy metropolitan Emergency Department: a review of real life management compared to best practice

• Murad A
• Katelaris

• KMID: 2396967
• DOI: http://doi.org/10.5415/apallergy.2016.6.1.29

Abstract

BACKGROUND
Deficiencies in anaphylaxis management in Emergency Departments is well recognised despite established guidelines for its treatment.
OBJECTIVE
To identify deficiencies in the management of anaphylaxis in a busy metropolitan Emergency Department and determine if an education intervention could correct these.
METHODS
Paediatric and adult admissions to the Emergency Department of a busy hospital were tracked over a 10-month period with a targeted educational program being instituted at 5 months. The electronic records were retrospectively reviewed looking for cases of anaphylaxis and milder forms of immediate type allergic reactions presenting with a combination of urticaria and nonairway threatening angioedema. Anaphylaxis presentation was graded using the Brown grading system. Use of all medication during resuscitation was documented. Observation period before discharge and referral to specialist unit for follow-up was noted.
RESULTS
In the first 5 months, 38 patients fulfilled our criteria. Three had severe anaphylaxis, 13 had moderately severe anaphylaxis and 12 had urticaria and angioedema without anaphylaxis. Anaphylaxis was not always recognised or graded leading to inappropriate management with adrenaline often being withheld. Promethazine, usually given in parenteral form, was frequently administered. Observation time was often inadequate. Referral to an immunologist was not universally followed through. Following the educational intervention 58 patients fulfilled our criteria over the next 5 months. The appropriate use of adrenaline increased by 21% and the use of sedating antihistamines decreased by 16%, while the number of referrals to an immunologist increased by 24%. There was an 11% reduction in the number of patients who were observed for at least 4 hours.
CONCLUSION
A number of deficiencies in the management of anaphylaxis presentations have been identified. Targeted educational activities aimed at the Emergency Department hospital staff may improve outcomes.

Keyword

Anaphylaxis; Clinical Audit; Emergency Department

MeSH Terms

Adult
Anaphylaxis*
Angioedema
Clinical Audit
Education
Emergencies*
Emergency Service, Hospital*
Epinephrine
Follow-Up Studies
Histamine H1 Antagonists
Humans
Hypersensitivity
Practice Guidelines as Topic*
Promethazine
Referral and Consultation
Resuscitation
Retrospective Studies
Specialization
Urticaria
Epinephrine
Histamine H1 Antagonists
Promethazine

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