Objectives & Background NICE guidance on anaphylaxis (Dec 2011) focuses on initial emergency management and onward referral. The guideline emphasises 5 main domains; documentation, tryptase sampling, observation, safe discharge and speciality follow up. Poor guidance compliance was highlighted during a departmental audit in 2012. An anaphylaxis care bundle was developed and implemented in response. We aimed to evaluate the impact of this bundle on departmental management of anaphylaxis.
Methods A retrospective case note review of all adult patients diagnosed with anaphylactic shock, identified from electronic records between 8/7/15–13/12/15 (cycle 1) and 30/3/16–17/5/16 (cycle 2) was conducted. A departmental anaphylaxis care bundle was introduced on 14/12/15. The bundle included a diagnostic checklist, clinical pathway, patient information leaflet and covering fax letter for the newly arranged allergy clinic direct referral. Implementation was supported by posters, educational sessions and staff emails. Performance was evaluated against the 5 main domains of the NICE guidance with the required standard of 100% compliance.
Results Cycles 1 and 2 identified 29 and 10 patients respectively. Performance improved across all 5 domains following the care bundle implementation. Documentation of time of onset improved from 17/29 to 10/10. Tryptase sampling at presentation and after 1–2 hours improved 4/29 and 2/29 respectively during cycle 1 to 9/10 and 9/10 during cycle 2. None of the patients in cycle 1 received advice regarding baseline tryptase compared to 9/10 in cycle 2. All 10 patients in cycle 2 were observed for at least 6 hours compared to 24/29 in cycle 1. In cycle 2 safe discharge was achieved in 9/10 patients compared to cycle 1 where 20/29 received epipens and 12/29 received information leaflets. Referral to specialist allergy services improved from 3/29 to 9/10.
Conclusion Following the introduction of the departmental anaphylaxis care bundle, more adult patients presenting with anaphylaxis are being managed, discharged and followed up in accordance with NICE guidelines. The concise algorithm could be an invaluable resource in other busy and high pressure departments. The importance of education, awareness, reinforcement and accessibility was important in achieving the improvements seen. Due to the rotational nature of junior staff on-going education is needed to ensure sustainability of the improved performance.⇓ ⇓ ⇓ ⇓ ⇓
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