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G62(P) Managing anaphylaxis: From incident to improvement
  1. H Boyd1,
  2. S Sukhani2,
  3. S Muthumeenal3,
  4. L Noimark3
  1. 1Paediatrics, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
  2. 2Respiratory Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  3. 3Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, UK

Abstract

Aims Anaphylaxis is an acute emergency, and early treatment with adrenaline can be life-saving. Our hospital Trust performs food challenges on a weekly basis. Following a serious incident involving a case of anaphylaxis during an oral food challenge, we identified that recognition and management of anaphylaxis was poorly understood amongst many members of the multi-disciplinary paediatric team.

Method Baseline knowledge of anaphylaxis treatment was assessed amongst paediatric staff. Interventions were then implemented including a case presentation, high fidelity in situ simulation, posters highlighting recognition and management of anaphylaxis and review of trust guidelines. Post intervention, staff members were re-assessed on their knowledge of anaphylaxis and demonstration of Epipen use.

Results Baseline data captured 47 staff members. 74% could not identify correct dose of adrenaline required. 45% did not know the correct concentration and 6% did not know route of administration. Although 79% had previous knowledge of using an Epipen, in 71% a dose of adrenaline would not have been delivered.

Following the interventions, 30 staff members were assessed. 100% correctly identified adrenaline as the first line treatment for anaphylaxis, 97% identified correct route of administration, 67% correct dose and 80% correct concentration of adrenaline.

87% questioned had attended a teaching session or seen the poster via email/distributed on the wards. 77% would have now successfully delivered a dose of adrenaline using the Epipen.

Conclusion Poor knowledge of anaphylaxis management amongst medical and nursing staff is prevalent, in particular around dosing and concentrations of adrenaline as well as correct use of Epipens, despite prior training.

A serious clinical incident was a catalyst to improve recognition and management of anaphylaxis amongst the multi-disciplinary team using various educational interventions, now incorporated into junior doctor induction. We are exploring strategies to address unmet learning needs at a regional level.

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