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Dr J Chapman and Dr R Parikh

Clinical Audit on: The Clinical Guidelines for Prescription of Epinephrine Auto Injectors (Epipen, Anapen) for Food Allergy in The Paediatric Allergy Clinic. Dr J Chapman and Dr R Parikh. Facilitated by Clinical Audit Office JPH. Introduction:.

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Dr J Chapman and Dr R Parikh

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  1. Clinical Audit on: The Clinical Guidelines for Prescription of Epinephrine Auto Injectors (Epipen, Anapen) for Food Allergy in The Paediatric Allergy Clinic Dr J Chapman and Dr R Parikh Facilitated by Clinical Audit Office JPH

  2. Introduction: • There has been a doubling of admissions for anaphylaxis in UK (1991-1995) • Food is the commonest cause with nuts being commonest to cause fatal reaction • The guidelines were prepared with the intention for proper use in diagnosis and management of Paediatric Food Allergy Patients attending our hospital

  3. Main Aim of guidelines: • To prevent deaths from food allergy induced anaphylaxis • To prevent over-prescription of an epinephrine auto injectors

  4. Brief aspects of guidelines- Grading of Worst Reaction:

  5. Criteria for prescription of epinephrine auto-injector: • The following patients should be prescribed an epinephrine auto-injector • Those with grade 4-5 reactions (moderate to severe) • Those with ongoing asthma of any cause • Those with a grade 1-3 reaction caused by trace exposure only • All patients, including those prescribed an epinephrine auto-injector, should be prescribed oral antihistamines (usually Piriton) for emergency use

  6. Objectives: • To ensure that allergic reactions to food are appropriately graded • To ensure that epinephrine auto-injectors are prescribed in accordance with current guidelines

  7. Methodology: • Retrospective study of 50 cases attending Paediatric Allergy Clinics • Time period between 1st July and 31st October 2003 • Specific data collection form to establish whether patients were graded and treated according to guidelines

  8. Results – Grading according to guidelines: (50 cases less 4 DNA) (n=46) %

  9. Results – Treated according to guidelines: (n=25) Antihistamines – all patients received antihistamines 100%

  10. Results – Out of Non-graded patients: (n=21) Not on Preferred Treatment – 6/7 Asthma : 1/7 Anaphylaxis on admission

  11. Results – Overall management of patients: (n=46) Not on Preferred Treatment – 4/11 (36%) Graded : 7/11 (64%) Not graded

  12. Results – summary: • Only 54% of patients were graded • The number of patients receiving Proper Treatment was 76% • All patients with grade 4 and 5 were given epinephrine auto-injectors • Those not receiving epinephrine majority of patients were asthmatic • All patients attending Allergy Clinics received antihistamines • The patients who were not graded and not on proper treatment were almost double those who were graded and not treated

  13. Scope of improvement: • All the patients should be graded according to severity which will give clear-cut picture of management due to excellent guidelines • All asthmatic patients should be given Epipen according to guidelines to prevent serious reaction

  14. Take Home Message: • All Professionals involved with Allergy Clinic should grade the patients and give treatment following it to ensure proper management of patients • If done it is not far to complete cycle of audit (needs a single tick on stickers)

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