EpiPen: How its use in Pediatric HospitalAnaphylaxis May Impact Efficiency and Patient Safety Melinda Hamilton,Michael Rosen, Nnenna Chime, Elizabeth Hunt
Background• Anaphylaxis fatalities1 – Fatal food reactions, arrest within 30-35 min – Insect stings, collapse from shock 10-15 min – Deaths after IV medications occur within 5 min• Errors with epinephrine administration – Concentration of medication – Dose of Medication – Administration site• Epinephrine Autoinjectors – Concentration and dose guaranteed – More timely – Ease of use ?? 1Pumphrey et al, Clin Exp Allerg 2000
PICO Question• Population – Pediatric code teams managing a simulated pediatric anaphylaxis scenario• Intervention – Will the use of an epinephrine autoinjector device decrease medication errors and decrease time to medication administration during pediatric anaphylaxis• Comparison – compared with standard administration (med, syringe) of epinephrine from a code cart• Outcome – Decrease medication errors (dose, concentration, site) and decrease time to medication administration
Approach• Several levels 1. Survey to children’s hospitals to understand their anaphylaxis protocols 2. Simulation testing to define concerns (pilot) 1. Standard epi administration vs autoinjector 1. Evaluate time, dose, concentration 2. Note errors 3. Randomized controlled trial of simulated anaphylaxis scenarios 1. Measure time to administration 2. Dose, concentration 3. Errors
3 Questions• What are children’s hospitals doing now?• Can we understand how big of an issue this is in pediatric hospitals?• What portions should be conducted at multiple centers ?