G98(P) Anaphylaxis or allergic reaction: service evaluation in a district general hospital

Abstract

Aims Anaphylaxis Care Pathways were introduced by RCPCH in 2011 to help health services achieve adequate standards of care for children presenting with anaphylaxis. We aimed to audit our local management against national standards. Method A retrospective audit was conducted including all patients admitted with Anaphylaxis between Feb and August 2014 with an aim to evaluate our practice against national standards. Total of 10 patients were identified who were referred via A&E department as anaphylaxis. Result Majority of patients were aged above 5 years. More then half of these children had associated food allergies.77% of our patients presented with mild allergic reaction and facial swelling was the commonest presenting symptom. IM adrenaline was given in 44% of patients. However, none of these patients have any life-threatening airway and/or breathing and/or circulation problems. These patients did not receive nebulised bronchodilator or adrenaline. All our patients were observed for 6–8 h. 77% of patients were prescribed adrenaline auto-injector on discharge however; none of these had documentation of training being given for auto-injector.100% of patients who were prescribed adrenaline auto injector had follow up arranged before discharge. Conclusion Lack of formal structure to the management of children who presented with allergic reaction or anaphylaxis was identified. Children who were managed as anaphylaxis did not meet criteria. Hence, strong need was felt to establish local guidelines for managing allergic reactions according to severity of reaction as well as clear definition for anaphylaxis. We introduced guidelines locally as an aide-memoir to facilitate consistency of care as per National standards. It was also recommended to include common paediatric emergencies as part of induction programme for both paediatric and A&E staff. We aim to re audit in six months.