Quality Statements
The Acute Anaphylaxis Clinical Care Standard contains six quality statements describing the key components of care to improve the recognition of anaphylaxis, and the provision of appropriate treatment and follow-up care.
Quality statements
The Acute Anaphylaxis Clinical Care Standard includes six quality statements. By describing what each statement means, the standard supports:
- Patients to know what care may be offered by their healthcare system, and to make informed treatment decisions in partnership with their clinician
- Clinicians to make decisions about appropriate care
- Health service organisations to understand the policies, procedures and organisational factors that can enable the delivery of high-quality care.
Some quality statements are linked to indicators to support monitoring of quality improvement. Follow the links below to read each quality statement in full.
- QS.1 Prompt recognition of anaphylaxis
A patient with acute-onset clinical deterioration with signs or symptoms of an allergic response is rapidly assessed for anaphylaxis, especially in the presence of an allergic trigger or a history of allergy.
- QS.2 Immediate injection of intramuscular adrenaline
A patient with anaphylaxis, or suspected anaphylaxis, is administered adrenaline intramuscularly without delay, before any other treatment including asthma medicines. Corticosteroids and antihistamines are not first-line treatments for anaphylaxis.
- QS.3 Correct patient positioning
A patient experiencing anaphylaxis is laid flat, or allowed to sit with legs extended if breathing is difficult. An infant is held or laid horizontally. The patient is not allowed to stand or walk during, or immediately after the event until they are assessed as safe to do so, even if they appear to have recovered.
- QS.4 Access to a personal adrenaline injector in all healthcare settings
A patient who has an adrenaline injector has access to it for self-administration during all healthcare encounters. This includes patients keeping their adrenaline injector safely at their bedside during a hospital admission.
- QS.5 Observation time following anaphylaxis
A patient treated for anaphylaxis remains under clinical observation for at least 4 hours after their last dose of adrenaline, or overnight as appropriate according to the Australasian Society of Clinical Immunology and Allergy Acute Management of Anaphylaxis guidelines. Observation timeframes are determined based on assessment and risk appraisal after initial treatment.
- QS.6 Discharge management and documentation
Before a patient leaves a healthcare facility after having anaphylaxis, they are advised about the suspected allergen, allergen avoidance strategies and post-discharge care. The discharge care plan is tailored to the allergen and includes details of the suspected allergen, the appropriate ASCIA Action Plan, and the need for prompt follow-up with a general practitioner and clinical immunology/allergy specialist review. Where there is a risk of re-exposure, the patient is prescribed a personal adrenaline injector and is trained in its use. Details of the allergen, the anaphylactic reaction and discharge care arrangements are documented in the patient’s healthcare record.
Goal
To improve the recognition of anaphylaxis, and the provision of appropriate treatment and follow-up care.
Scope
The Acute Anaphylaxis Clinical Care Standard relates to the care provided to adults, children and infants when they are experiencing anaphylaxis – from initial presentation to a healthcare setting or first clinical contact in the community, through to discharge and planning for follow-up care. It also applies to many patients who experience anaphylaxis while in a healthcare facility (see ‘What is not covered’).
Pathway of care
This standard applies to care provided in the following care settings:
- Hospitals, including public and private hospitals, subacute facilities, day procedure services and outpatient clinics
- Emergency services, such as ambulance services
- Radiology and imaging services
- General practices
- Other primary healthcare settings, such as Aboriginal Controlled Health Services and community pharmacies.
In this document, the term ‘clinician’ refers to all types of healthcare providers who deliver direct clinical care to patients, including:
- Nurses
- Midwives
- Medical practitioners
- Allied health practitioners
- Paramedics
- Community & hospital pharmacists
- Students who provide health care under supervision.
What is not covered
The Acute Anaphylaxis Clinical Care Standard does not include:
- The management of anaphylaxis in patients in operating theatres and intensive care units where specialised clinical expertise and haemodynamic monitoring are available
- Detailed assessment of allergies and their management
- Care provided by schoolteachers, bystanders or other non-medically trained people
- Food management in healthcare facilities. Note: All about Allergens for Hospitals is a free National Allergy Strategy online training course for food allergen management (and ward staff) in Australian hospitals, available from https://foodallergytraining.org.au/