It is estimated that 20 people die each year from anaphylaxis (Pumphrey 2000). NICE(2011) identify many patients receive sub-optimal treatment and follow up for anaphylaxis identifying that many healthcare providers do not understand how to make a diagnosis or appropriately follow up a patient who has suffered a life threatening allergic reaction. UHC developed a clinical pathway for the treatment, observation and follow up of patient with anaphylaxis. This was employed to reduce variation in treatment allowing for increased efficacy of clinical resources (Rosique 2008). In a novel approach to pathway introduction and training, multidisciplinary high fidelity in situ training was used to introduce the pathway and identify any potential latent risks in the clinical environment.
The scenario outcomes were defined by the clinical decisions unit lead clinician and the simulation clinical lead. The training was run with great success in one district general and then spread to a second district general as it became the core training for all nurses involved. Through use of ‘live’ drugs and rescue/response systems was able to identify a number of latent risks in the fabric of each department.
The multidisciplinary team reported increased confidence in the recognition and management of patients with anaphylaxis and improved understanding of the role of the clinical decision unit pathway. The senior clinical team were able to make some fundamental changes to department and access to emergency drugs that addressed otherwise potentially harmful delays to the access of adrenaline and other resuscitation adjuncts.
In conclusion, the structure/layout of our healthcare areas often creates significant barriers in the access to emergency care. Whilst classroom based training can increase recognition of anaphylaxis, there is no guarantee that the clinical environment can facilitate safe effective care unless we test it. High-fidelity in-situ training offers a novel solution to both needs.
Resuscitation Council (UK) 2008. Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers
Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clinical and Experimental Allergy 2000;30(8): 1144–50
National Institute for Health Care Excellence (2011) Intial Assessment and referral following emergency treatment for anaphylactic episode CG 134 NICE
- Category: Course or curriculum evaluation/innovation/integration
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