G584 An audit of the emergency management of anaphylaxis in children in secondary care. (25th October 2020)

• Record Type: Journal Article
• Authors: Stratford, A; Sharma, V; Ali, A; Ventilacion, L
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A209
• Page End: A210
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.501
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim/Objective: There is an increasing incidence in anaphylaxis reported globally and in the UK. Due to this, there is raised anxiety in our local population around the management of anaphylaxis, especially in light of the shortage of adrenaline auto-injector pens last year. The aim of this audit project is to assess the management of paediatric patients presenting with anaphylaxis to the Paediatrics Emergency Department (PED) and Children's assessment Unit (CAU) and whether they are appropriately managed in accordance with current NICE and local guidelines. Methods: We reviewed the notes of patients who present to PED and CAU from June 2018 until January 2019. Patients were identified through search words such as 'anaphylaxis' and 'allergic reaction' in coding. The notes were reviewed and data collected using the Anaphylaxis Audit Proforma. Results: 26 patients were identified based on the keyword search. 6/26 patients (19 months – 15 years) fulfilled the diagnostic criteria of anaphylaxis; however, only 2/6 had clearly documented diagnosis of anaphylaxis. All 6 were treated with Chlorphenamine; 4/6 had IM adrenaline; and 4/6 had IV Hydrocortisone. 3/6 patients did not have an identifiable allergen trigger, all of whom did not have a tryptase level taken. 5/6 had minimum recommended time of 6 hours of observation. At discharge, 4/6 patients had an auto-injector prescribed and training provided. All patients had documented safety-advice given, with an anaphylaxis action plan provided to 4/6. Overall, specific documentation pertaining to information on discharge, including risk of biphasic reaction (1/6), was poor. Reassuringly, all patients were referred to the allergy clinic. Conclusions: This audit identifies the need for further education on recognition, correct diagnosis and management of anaphylaxis, with emphasis on clear documentation especially of safety-net information given at discharge. Promoting use of the Anaphylaxis Proforma and guideline aims to improve safety and standardise the care of patients presenting with anaphylaxis.