CP01 Emergency Treatment of Anaphylactic Reactions - Devon ...

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Document Control Version Date Issued Author Name / Job Title / Email 1.0 September 2009 Amanda Gulbranson Clinical Effectiveness Lead - Medicine Management amanda.gulbranson@nhs.net 2.0 March 2011 Deborah Marriott Lead Clinical network Pharmacist (Exeter, East and Mid) Deborah.marriott@nhs.net Kelly Smith Prescribing Information Analyst Kelly.smith8@nhs.net 3.0 May 2012 Amanda Gulbranson 4.0 March 2013 Clinical Effectiveness Lead - Medicine Management 5.0 March 2014 amanda.gulbranson@nhs.net Target audience / staff groups: Ratifying Group: Date ratified: March 2014 Implementation date: March 2014 Review date: March 2016 Clinical staff: All inpatient units and staff responsible for the administration of vaccines Medicines Management Governance Group Document History Version Start End date Author History date 1.0 September 2009 AG New Protocol signed off. Replaces PGDs for adrenaline for treatment of anaphylaxis 1.1 05.01.11 05.01.11 KS Added reference and hyperlink to Anaphylaxis eLearning package 1.2 05.01.11 01.03.11 DM/KS Appendix 1 now includes the following: - To call 999 - Record time adrenaline administered - Administer oxygen only if difficulty in breathing Add that Anaphylaxis pack to be stored in Treatment Room with other emergency equipment (not locked away). Add that the person should not be left alone until emergency services arrive. 2.0 22.03.11 22.03.11 KS Document signed off. 2.1 May 12 AG Review of protocol to reflect Clinical Guidance issued by NICE (CG134) December 2011 Sections 3.11, 4.2 bullet point 2 & 4.4 added 3.0 May 12 KS Version 3 signed off. 3.1 Mar 13 21.03.13 AG Contents of anaphylactic packs reviewed Anaphylaxis pack to be stored in emergency Equipment bag Information contained in algorithm (Appendix 1) minimised. Section added regarding patient’s own adrenaline autoinjector devices. 4.0 Apr13 KS Version 4 signed off 4.1 Feb14 Mar14 AG Anaphylaxis pack & contents reviewed in order to comply with EU Council Directive 2010/32/EU and availability of 500microgram adrenaline auto-injector device. 5.0 Mar14 KS Document ratified at DTC and signed off. CP 01 - Protocol for the Emergency Treatment of Anaphylactic Reactions Approved by Drugs and Therapeutics Committee: March 2014 Review Date: March 2016 Page 2 of 8
1. Introduction 1.1 This protocol covers the recognition, assessment and treatment of anaphylactic reactions and is intended to be read in conjunction with the Resuscitation Council (UK) Guidelines for the Emergency Treatment of Anaphylactic Reactions. 1.2 Anaphylaxis can be defined as ‘a severe, life-threatening, generalised or systemic hypersensitivity reaction’. Anaphylaxis is characterised by rapidly developing lifethreatening airway, breathing and /or circulation problems, usually associated with skin and mucosal changes. 1.3 Anaphylactic reactions may follow exposure to a variety of agents, with insect stings, drugs (e.g. antibiotics, non-steroidal anti-inflammatory drugs, parenteral vitamins such as Pabrinex ® ) and some foods being the most common. Peanut and tree nut allergy now accounts for a significant incidence of anaphylaxis. Beta blockers may increase the severity of an anaphylactic reaction and antagonise the response to adrenaline (the decision to prescribe a beta-blocker to a patient at increased risk of an anaphylactic reaction should only be made after assessment by an allergist and cardiologist). 1.4 A low rate of anaphylaxis has been observed following vaccination based on reports to the Vaccine Adverse Event Reporting System (VAERS) with an estimated incidence of 1 case in 600,000 vaccine doses distributed. None of the reported cases were fatal, however anaphylaxis can be fatal and vaccinations can (in very rare instances) cause a lifethreatening hypersensitivity reaction in certain individuals. Further administration of vaccines or specific medication is contraindicated in people with a history of anaphylaxis after a previous dose 1.5 The lack of any consistent clinical manifestation makes the diagnosis of anaphylaxis difficult. All clinicians who treat anaphylaxis should be aware of possible differential diagnoses (i.e. vasovagal attacks or panic attacks) 2 Emergency Medication 2.1 The following medication will be stocked for the emergency management of anaphylaxis in accordance with this protocol; o 3 x Adrenaline (1:1000) auto-injector devices (500micrograms/ 0.5mls) Brand may vary NB. Anti-histamines (chlorphenamine) and corticosteroids (hydrocortisone) NOT included. These are second-line treatments, and will be administered by paramedics or acute trust clinicians if indicated. 2.2 Emergency medication for the management of anaphylaxis will be held as stock on All inpatient units Community teams where vaccination programmes are offered (i.e. substance misuse services) and where individual workers administer vaccinations in the course of their work Note: Community psychiatric nurses solely administering antipsychotic depot injections need not carry an anaphylaxis treatment pack. Refer to section 4.3.2 of this document and Trust guidelines for the administration of antipsychotic depot injections. 2.3 The emergency medication will be stored with the unit’s Emergency Resuscitation Equipment in the central (tamper-evident) section of the Emergency Equipment Bag (Fig 1) OR on the Resuscitation/Crash team trolley (co-located wards only) CP 01 - Protocol for the Emergency Treatment of Anaphylactic Reactions Approved by Drugs and Therapeutics Committee: March 2014 Review Date: March 2016 Page 3 of 8
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CP01 Emergency Treatment of Anaphylactic Reactions - Devon ...

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