Anaphylactic Reaction Emergency Treatment Reference Number:

Transcription

1 This is an official Northern Trust policy and should not be edited in any way Anaphylactic Reaction Emergency Treatment Reference Number: NHSCT/12/551 Target audience: Nursing Staff Groups included are: Public Health Nursing Services -(School Nursing, Health Visiting) Health Protection Nursing Services Community Children s Nursing Services Adult Community Nursing Services Sources of advice in relation to this document: Maeve McGuigan, Lead Public Health Nurse Ashley Ramsay, Assistant Community General Manager Carolyn Kerr, Deputy Director of Nursing Replaces (if appropriate): NHSCT Emergency Treatment of an Anaphylactic Reaction in the Community (NHSCT/09/216) Type of Document: Trust Wide Approved by: Policy, Standards and Guidelines Committee Date Approved: 14 March 2012 Date Issued by Policy Unit: 11 June 2012 NHSCT Mission Statement To provide for all the quality of services we would expect for our families and ourselves 1

2 Emergency Treatment of an anaphylactic reaction in the Community Protocol for Public Health Nursing - (School Nursing, Health Visiting); Health Protection Nursing Services; Community Children s Nursing Services.; and Adult Community Nursing Services Revision March

3 Emergency treatment of an anaphylactic reaction in the Community Protocol For Public Health Nursing - (School Nursing, Health Visiting); Health Protection Nursing Services; Community Children s Nursing Services; and Adult Community Nursing Services Introduction Episodes of anaphylactic reaction appear to be increasingly common and have been strongly associated with the increasing prevalence of allergy type illnesses over the last two or three decades (Resuscitation Council (UK), 2008 It is recognised that the treatment of anaphylaxis continues to be variable and there is a need for a consistent approach which draws together relevant and appropriate expertise as provided by the Resuscitation Council (UK), Aim of Protocol This protocol outlines procedures and practices within the Northern Health & Social Care Trust (NHSCT) for registered nursing staff (see nursing staff groups below) who are expected to deal with anaphylactic reactions during their usual clinical role, working for example within community hospitals, GP practices and schools. Target Audience Nursing Staff Groups included are: Public Health Nursing Services -(School Nursing, Health Visiting) Health Protection Nursing Services Community Children s Nursing Services Adult Community Nursing Services Responsibilities Assistant Director The Assistant Director for Children s and Related Services and Adult Community Nursing Services have overall responsibility for monitoring the implementation and operation of this policy. 3

4 Lead /Senior Nurse The Lead/Senior Nurse in adult community nursing, public health nursing and community children s nursing service has operational responsibility for monitoring the implementation and operation of this policy. Adult Community Nursing, Public Health Nursing & Community Children s Nursing Staff Staff have responsibility to familiarise themselves and follow the emergency treatment of an anaphylactic reaction in community protocol Legislative compliance This should be read in conjunction with:- Emergency treatment of anaphylactic reactions guidelines for healthcare providers Working Group of the Resuscitation Council (UK), January 2008 Published by the Resuscitation Council (UK). Equality, Human Rights and DDA The policy is purely clinical/technical in nature and will have no bearing in terms of its likely impact on equality of opportunity or good relations for people within the equality and good relations categories. Alternative formats This document can be made available on request on disc, larger font, Braille, audiocassette and in other minority languages to meet the needs of those who are not fluent in English. Sources of Advice in relation to this document The Policy Author, responsible Assistant Director or Director as detailed on the policy title page should be contacted with regard to any queries on the content of this policy Policy Statement Definition of Anaphylaxis Anaphylaxis is a severe, life threatening, generalised or systematic hypersensitivity reaction characterised by rapidly developing life threatening airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes. Resuscitation Council (UK)

5 Management of Anaphylactic Reactions The minimal level of care that any patient with an anaphylactic reaction should expect to receive includes: 1. Recognition that they are seriously unwell 2. Early call for emergency help 3. Initial assessment and treatments based on ABCDE approach 4. Adrenaline (Epinephrine) therapy if indicated 5. Investigation and follow up by an allergy specialist 1. Recognition that they are seriously unwell Exposure to a known allergen Sudden onset and rapid progression of symptoms Life-threatening Airway and/or Breathing and/or Circulation problems Skin and/or mucosal changes (flushing, urticaria, angioedema) 2. Early call for emergency help. When dealing with an anaphylactic reaction within the community it is vital to call for a Paramedic ambulance immediately by dialling do not leave the patient alone unless absolutely necessary. 3. Initial assessment and treatment based on ABCDE approach o Airway - Any swelling, difficulty breathing or swallowing, hoarse voice or stridor o Breathing Shortness of breath, wheeze, drop in oxygen saturation or signs of respiratory distress. o Circulation Pale, clammy, increased heart rate or drop in blood pressure. o Disability Agitation, confusion or loss of consciousness. o Exposure Look for any signs of rash, present in 80% of Anaphylactic reactions Patients should be positioned according to their presenting condition. If they have respiratory difficulty then they may prefer to sit upright. If they have low blood pressure lay down with their legs elevated. If they are unconscious and breathing they should be placed on their left side to prevent caval compression. If possible the trigger should be removed, but this is not always possible. 4. Adrenaline (Epinephrine) therapy if indicated In an anaphylactic emergency situation, which requires life saving measures, consent, by the patient, to the administration of intramuscular (I.M) Adrenaline (Epinephrine) is not required. IM Adrenaline (Epinephrine) can be administered without a doctor s prescription in such an emergency situation. Resuscitation Council (UK)

6 In the NHSCT the Regional PGD for Adrenaline is the agreed prescription in such an emergency situation. The algorithm for the management of anaphylactic reactions produced by the Resuscitation Council (UK) is contained within Appendix 1 and an example of an emergency adrenaline pack contents is contained within Appendix 2. NB Where a patient /child is found to be unresponsive, not breathing or has no pulse present, cardio pulmonary resuscitation (CPR) must be commenced immediately. Adrenaline (Epinephrine) auto-injectors (eg Epipen, JEXT, Anapen) Auto-injectors are often given to patients at risk of anaphylaxis for their own use. Currently two doses of Adrenaline (Epinephrine) auto-injector are commonly available: 0.15 and 0.3 mg. Allergy specialists should prescribe the most appropriate dose of an auto-injector for individual patients. The dose recommendations for Adrenaline (Epinephrine) in this protocol are intended for staff treating an anaphylactic reaction. If an Adrenaline (Epinephrine) auto-injector is the only available Adrenaline (Epinephrine) preparation when treating anaphylaxis, staff should use it. Resuscitation Council (UK) 2008 Emergency Adrenaline (Epinephrine) Pack An emergency pack must be available to all staff who are administering any drug. Example of an emergency pack contents are detailed within Appendix 2. Each staff member is accountable and responsible for ensuring that his or her individual Adrenaline (Epinephrine) pack is fully equipped, stored securely at all times and that drugs are in date. Adrenaline (Epinephrine) packs should not be left with individual patients but taken by the staff member on all visits if required. Adrenaline (Epinephrine) must not be stored for long periods in places of extremes temperature such as the car and should be protected from the light. Dose Age I.M Dose of Adrenaline (Epinephrine) 1:1000 BP Child less than 6 years 150 micrograms IM (0.15ml) Child 6-12 years 300 micrograms IM (0.3ml) Child more than 12 Years 500 micrograms IM (0.5ml) 300micrograms IM (0.3ml) if child small or prepubertal Adult 500 micrograms IM (0.5ml) Use suitable syringe for measuring small volume 6

7 Route of administration - By Intramuscular injection only, preferred site is anterolateral aspect of the thigh Standard UK needle gauges and lengths Blue needles (25mm, 23G) are suitable for all ages. Orange needles (16mm or 25mm, 25G) for pre-term or very small infants. Frequency of administration Repeat IM adrenaline (Epinephrine) dose if there is no improvement in the patient s condition. Further doses can be given at about 5-minute intervals according to the patient s response. Resuscitation Council (UK) Records All incidents of anaphylactic reaction must be recorded in patient s records and an incident form completed. The line manager must be informed as soon as is practically possible. All cases of adverse drug reactions including anaphylaxis should be reported to the Medicines and Healthcare Products Regulatory Agency (MHRA) using the Yellow card scheme The British National Formulary (BNF) includes copies of the Yellow card at the back of each edition. All anaphylactic reactions should be reported to the patient s GP or inpatient doctor for follow up to a specialist allergy clinic. Resuscitation Council (UK) Web site Link for Emergency Treatment of Anaphylactic Reactions The key steps for the treatment of an anaphylactic reaction are shown in the algorithm in Appendix 1 Example of an emergency packs are detailed in Appendix 2 Training Staff employed by NHSCT who are expected to deal with anaphylactic reactions during their usual clinical role, must attend annual mandatory Basic Life Support and Anaphylaxis Training appropriate to their field of practice. References Emergency treatment of anaphylactic reactions Guidelines for healthcare providers Working Group of the Resuscitation Council (UK), January 2008 Published by the Resuscitation Council (UK). 7

8 Appendix 1 Repeat the IM adrenaline (Epinephrine) dose if there is no improvement in the patient s condition. Further doses can be given at about 5-minute intervals according to the patient s response. NB Where a patient /child is found to be unresponsive, not breathing or has no pulse present, cardio pulmonary resuscitation (CPR) must be commenced. 8

9 Treatment of Anaphylaxis Example of an Emergency Pack Appendix 2 SECTION CONTENTS BATCH NO/ EXPIRY DATE ONE 1 amp Adrenaline (Epinephrine) Injection 1mg in 1ml (1 in 1000) Needles 1 filter needle, 2 blue needle, 2 orange needle Syringe (2ml) Syringe (1ml) TWO 2 amps Adrenaline (Epinephrine) as above Needles 1 filter needle, 2 blue needle, 2 orange needles 2ml Syringes 1ml Syringes THREE Gloves Spare Needles / including filter needle Spare syringes (1 ml) Laerdal Pocket Mask/Adult/Paediatric Alcotip swabs Sharps box NB - Emergency packs must be checked on a monthly basis to ensure drugs are within the expiry date and a record kept at local level. 9