Improving paediatric anaphylaxis management outcomes in the emergency department through targeted educational activities: A 3-year retrospective audit in a victorian regional centre.

Abstract

Background: A recent state-wide publication from the Victorian Paediatric Clinical Network Anaphylaxis Expert Group has provided recommendations on discharge procedures from the Emergency Department to address deficiencies in paediatric anaphylaxis management. Objective(s): To determine if a targeted education program to Emergency Department staff leads to improved management of paediatric anaphylaxis within the department and at discharge. Method(s): A retrospective review of the electronic records of all paediatric presentations to the emergency department at a large regional centre over a 3-year period was performed on entries containing final diagnoses terms of anaphylaxis, allergy unspecified, dermatitis due to ingested food, food reaction non-dermatitis, urticaria and vaccine complication. Targeted education was introduced at 12- and 18-months during the 3-year study period consisting of a single, 40-min audio-visual presentation by paediatric staff to Emergency Department staff. Result(s): In the first 12 months prior to targeted education, 17 patients fulfilled the Australasian Society of Clinical Immunology and Allergy (ASCIA) clinical diagnostic criteria for anaphylaxis. 8 patients (47%) were given an alternative, less serious, diagnosis. Only 4 patients (40%) were given adrenalin in the emergency department. At discharge, only 2 patients (20%) were given EpiPen prescription with no documented training; 1 patient (10%) received an anaphylaxis management plan and none were referred to an allergy specialist. Following the targeted education program, 22 patients fulfilled ASCIA clinical diagnostic criteria for anaphylaxis. 9 patients (43%) were given an alternative, less serious, diagnosis. The appropriate use of adrenalin increased by 21%. At discharge, the supply of an EpiPenR prescription with documented training increased by 19%; the supply of an anaphylaxis management plan increased by 16% and referral to an allergy specialist increased by 33%. Conclusion(s): Targeted education with minimal time and specialist knowledge requirements to Emergency Department staff improves management of paediatric anaphylaxis within the department and at discharge.