P22: ANAPHYLAXIS RISK MANAGEMENT PROGRAM ENHANCES EMERGENCY CARE OF ANAPHYLAXIS

Abstract

The purpose of this audit was to review anaphylaxis management for a 6-month cohort of anaphylaxis presentations to Southern Adelaide Local Health Network (SALHN) Emergency Departments (EDs). All anaphylaxis presentations to SALHN EDs between 1 July 2014 and 31 December 2014, identified by the SALHN Allergy Clinical Immunology (ACI) Service nurse-led Anaphylaxis Risk Management Program, were retrospectively audited. Automated hospital database searches report new anaphylaxis presentations to the ACI Service. Completeness of acute management and discharge risk mitigation measures is ascertained from case notes and prospectively entered into Excel by ACI nurses, for anaphylaxis cases (grades 2 and 3, Simon Brown). Staff address omissions by contacting patients and educating ED and ward staff. There were 96 presentations to ED with anaphylaxis. 69 (65%) were grade 2 and 21 (26%) were grade 3 reactions. No grade was assigned for 6 (6%) identified by ACI staff as anaphylaxis. Food was the most common trigger, accounting for 57 (59%) of presentations. No cause was identified in 13 (13.5%) of cases. A total of 90 adrenaline doses were administered to 72 (75%) presentations; the route was intramuscular for 86 (96%) of doses. 73 (76%) were observed in hospital for 4 or more hours. Adrenaline auto-injectors were prescribed to 60 (63%) of all presentations with anaphylaxis. 47 (48%) were discharged with an anaphylaxis action plan. Case note alerts were completed for 24 (25%) presentations. 47 (48%) were referred to specialist ACI services or were already receiving specialist management. Our findings support previous research that anaphylaxis remains under-treated. A substantial proportion did not receive adrenaline and discharge risk mitigation measures were incomplete, increasing the risk of adverse outcome. Current SALHN ACI Service proactive review to complete management of all anaphylaxis presentations remains indicated.