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Guia NICE sobre anafilaxia. implementacion


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Presentación de ayuda a la implementación de las recomendaciones de la GPC NICE sobre anafilaxia

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Guia NICE sobre anafilaxia. implementacion

  1. 1. Anaphylaxis: assessment and referral Implementing NICE guidance December 2011 NICE clinical guideline 134
  2. 2. What this presentation covers <ul><li>Background </li></ul><ul><li>Scope </li></ul><ul><li>Recommendations </li></ul><ul><li>Costs and savings Discussion </li></ul><ul><li>NICE Pathway </li></ul><ul><li>NHS Evidence </li></ul><ul><li>Find out more </li></ul>Image reproduced with kind permission of Dr Pete Smith,
  3. 3. Background <ul><li>There are four common triggers – drug, food, latex and insect venom – plus an idiopathic group where the trigger is not known </li></ul><ul><li>Approximately 1 in 1333 of the population of England has experienced anaphylaxis at some point in their lives </li></ul><ul><li>There are approximately 20 deaths from anaphylaxis reported each year in the UK </li></ul>
  4. 4. Scope <ul><li>This guideline covers adults, young people and children who receive emergency treatment for suspected anaphylaxis. </li></ul><ul><li>It covers </li></ul><ul><li>clinical assessment following emergency treatment </li></ul><ul><li>provision of adrenaline auto-injectors </li></ul><ul><li>referral </li></ul><ul><li>information needs and provision </li></ul>
  5. 5. Definitions <ul><li>Anaphylaxis – a severe, life-threatening, generalised or systemic hypersensitivity reaction </li></ul><ul><li>Biphasic anaphylaxis – after complete recovery of anaphylaxis, a recurrence of symptoms within 72 hours with no further exposure to the allergen </li></ul><ul><li>Idiopathic anaphylaxis – a form of anaphylaxis where no identifiable trigger can be found </li></ul><ul><li>Recurrence – a return of symptoms as part of the natural progress of a disease </li></ul><ul><li>Suspected anaphylaxis – the diagnosis prior to assessment by a specialist allergist for people who present with symptoms of anaphylaxis </li></ul>
  6. 6. Recommendations <ul><ul><li>Clinical assessment after emergency treatment </li></ul></ul><ul><ul><li>Mast cell tryptase testing </li></ul></ul><ul><ul><li>Observation or admittance to hospital (for children) </li></ul></ul><ul><ul><li>Referral </li></ul></ul><ul><ul><li>Discharge </li></ul></ul><ul><ul><li>Referral pathways </li></ul></ul>
  7. 7. <ul><ul><li>Document the acute clinical features of the suspected anaphylactic reaction </li></ul></ul><ul><ul><li>Record the time of onset of the reaction </li></ul></ul><ul><ul><li>Record the circumstances immediately before the onset of symptoms to help to identify the possible trigger </li></ul></ul>Clinical assessment after emergency treatment
  8. 8. <ul><ul><li>In adults or young people 16 years or older take timed blood samples for mast cell tryptase </li></ul></ul><ul><ul><li>In children younger than 16 years consider taking blood samples for mast cell tryptase if the cause is thought to be venom-related, drug-related or idiopathic </li></ul></ul><ul><ul><li>Take </li></ul></ul><ul><ul><ul><ul><li>a sample as soon as possible after emergency treatment has started </li></ul></ul></ul></ul><ul><ul><ul><ul><li>a second sample ideally within 1–2 hours (but no later than 4 hours) from the onset of symptoms </li></ul></ul></ul></ul>Mast cell tryptase testing
  9. 9. <ul><ul><li>Adults and young people aged 16 and over should be observed for 6–12 hours from the onset of symptoms </li></ul></ul><ul><ul><li>With appropriate post-reaction care, those whose reactions were controlled promptly and easily, may be observed for a shorter period </li></ul></ul><ul><ul><li>Children under 16 years should be admitted to hospital under the care of a paediatric medical team </li></ul></ul>Observation
  10. 10. <ul><ul><li>After emergency treatment for suspected anaphylaxis </li></ul></ul><ul><ul><li>Offer a referral to a specialist allergy service (age-appropriate where possible) </li></ul></ul><ul><ul><li>Offer an appropriate adrenaline injector as an interim measure before the specialist allergy service appointment </li></ul></ul>Referral
  11. 11. Discharge <ul><li>Before discharge offer </li></ul><ul><li>information about anaphylaxis, including signs and symptoms of an anaphylactic reaction </li></ul><ul><li>information about the risk of biphasic reaction </li></ul><ul><li>information on what to do if an anaphylactic reaction occurs </li></ul><ul><li>a demonstration of use of the adrenalin injector and when to use it </li></ul><ul><li>advice regarding avoidance of the suspected trigger (if known) </li></ul><ul><li>information about the need for referral to the specialist allergy service and the referral process </li></ul><ul><li>information about patient support groups </li></ul>
  12. 12. Referral pathways <ul><li>Each hospital providing emergency treatment for suspected anaphylaxis should have separate referral pathways for suspected anaphylaxis in adults (and young people) and children </li></ul>
  13. 13. Costs and savings <ul><li>This guideline is unlikely to result in a significant change in resource use in the NHS </li></ul><ul><ul><li>However, recommendations 1.1.9 and 1.1.12, which concern referral to a specialist allergy service following a suspected anaphylactic reaction, may result in additional costs/savings depending on local circumstances </li></ul></ul>
  14. 14. Discussion <ul><li>What are the training needs of staff with regards to provision of adrenaline injectors and information for patients? </li></ul><ul><li>What specialist services are available locally for referral, and are referral pathways in place? </li></ul><ul><li>What information do we currently provide to patients who have had an anaphylactic reaction? How does this need to be changed to meet the recommendations in the guideline? </li></ul>
  15. 15. NICE Pathway <ul><li>The NICE anaphylaxis pathway covers assessment to confirm an anaphylactic reaction and the decision to refer after emergency treatment for a suspected anaphylactic reaction. </li></ul>Click here to go to NICE Pathways website
  16. 16. NHS Evidence <ul><ul><li>Visit NHS Evidence for the best available evidence on all aspects of health and social care. </li></ul></ul>Click here to go to the NHS Evidence website
  17. 17. Find out more <ul><li>Visit for: </li></ul><ul><ul><li>the guideline </li></ul></ul><ul><ul><li>‘ Understanding NICE guidance’ </li></ul></ul><ul><ul><li>costing statement </li></ul></ul><ul><ul><li>audit support </li></ul></ul>
  18. 18. What do you think? Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our tools. Please complete a short evaluation form by clicking here . If you are experiencing problems accessing or using this tool, please email [email_address] To open the links in this slide – right click over the link and choose ‘open hyperlink’. NB. Not part of presentation