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Impact of national guidelines on reporting anaphylaxis during anaesthesia – an outcome audit
Author(s) -
FREEMAN S. G.,
LOVE N. J.,
MISBAH S. A.,
POLLARD R. C.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12173
Subject(s) - medicine , anaphylaxis , guideline , referral , audit , emergency medicine , perioperative , medline , general anaesthesia , intensive care medicine , pediatrics , medical emergency , allergy , anesthesia , family medicine , management , pathology , political science , economics , law , immunology
Aims Anaphylaxis during anaesthesia is a rare and potentially fatal event. Adequate reporting and investigation of anaphylaxis associated with anaesthesia results in improved patient safety and outcomes. Guidelines from the A ssociation of A naesthetists of G reat B ritain and I reland ( AAGBI ) designed to improve this process were first issued in 1990 and updated in 1995, 2003 and 2008. In a setting where no formal guideline was previously in place, we compared the reporting and investigation of anaphylaxis in a large hospital before and after the introduction of the 2008 guideline. Methods A retrospective outcome audit was conducted to compare data from 12 patients referred from A pril 2006 to M ay 2008 prior to release of the 2008 AAGBI guidance, with 53 patients referred from 2008 until A pril 2011. Data were collected using the AAGBI A naphylaxis R eferral F orm. Results There was an increase in the number of referrals for suspected anaphylaxis following implementation of the AAGBI guidance. The clinical features observed in patients were consistent with previous studies. There was improved documentation of referral to local and national databases. Most cases resulted in cancellation of surgery, and there were no patient deaths. A substantial increase in the number of patients with amoxicillin allergy was noted in the second time period, which was linked to a change in the local perioperative antibiotic policy. Conclusions Implementation of the AAGBI guidelines locally in a large hospital in 2008 resulted in an improved awareness of the importance of reporting and investigation of suspected anaphylaxis under anaesthesia. This tool was implemented coincidentally with the change in hospital antibiotic prophylaxis and enabled the cases detected to be accurately recorded and investigated. This led to a change in the hospital antibiotic policy for surgical prophylaxis. Implementation of structured guidance from a national anaesthesia organisation enhances recognition of the clinical features of anaphylaxis, increases number and completeness of referrals and more thorough immunological investigation, leading to improved patient safety during anaesthesia.